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CBCT Scan / OPG Referrals

CBCT Scan / OPG Referrals2017-05-22T16:41:41+00:00

Please note all fields are mandatory unless otherwise stated.

Referring Dentist Details

Patient's Details

Referral Information

Firstly are the requested scans justified? YesNo

CBCT scans will come with one CD and viewing software.

Digital OPG

YesNo

Digital Ceph

YesNo

Additional Information