Imaging Referral Request

Patient form

Please fill in the form details for your online digital imaging referral.

Fields marked * are required and must be completed

2D Digital Examination Details

3D CBCT Examination Details

Course of Treatment

Payment

We do not routinely report on scans or radiographs. To comply with IRMER 2000 Regulations all radiographs and scans are required to be reviewed and reported into the clinical notes by the referring practitioner or by a radiologist. We can arrange for a report to be prepared by a Consultant Radiologist if this is requested by you (please note, this will incur a further charge depending on size of scan).

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