161 Bromley Road

Catford, London SE6 2NZ

0208 6980491

enquiries@maxidentclinic.com

 

3D Imaging Referral Form

3D Imaging Referral Form

This form is strictly for referring Dentist practitioners only!

You can refer your patient by completing the referral form below. Alternatively, you can download a copy of the referral form and send it to the practice via post or email.

CT SCAN £99.00

OPG £50.00

Download CT Scan Referral Form

download-referral-form

Page 1 of 3

Referring Dentist Details

Patient's Details

Medical History & Referral Information

CBCT scans will come with one CD and viewing software.

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Book A No Obligation ConsultationIf you need any dental treatment or would like to learn more about any dental treatment then why not book a no obligation consultation with one of our expert practitioners. At your consultation you will be able to discuss the procedure in detail and ask any questions you may have.