CBCT Referral Form

We’re always happy to discuss cases. Please get in touch via the form below or call us on 01977 682 200.

Finkle Hill Dental Care Panoramic & CBCT Referral

We welcome referrals from our dentist colleagues for routine, specialist and aesthetic dental care. Please complete the form below and we’ll contact you and your patient as soon as possible.

"*" indicates required fields

Referring Practice Details

Address*
Referring Dentist Name*

Patient Details

Full Name*
Date of Birth*
Address*

2D Imaging

2D Imaging

Please note: Only the requested OPG/CBCT will be provided. We are not able to report on any of the images we take.

Data Protection

Data Protection*
This field is for validation purposes and should be left unchanged.
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