ExeterAdvancedDentistry Matt Austin

CBCT/OPG Scan Referrals

Firstly we would like to say a big thank you for taking the time to consider our referral service and how we may be able to work together in the future to help your patients. This page should help you understand how we work with other referring dentists. You may also find it useful to direct your own patients to the patient referral page as it gives a step by step guide to how the process works between us. If you have any questions then please just drop us a line and we can have a chat.

CBCT / OPG Referral Form

Referring Dentist's Details

Referring Dentist Name(Required)

Patient Details

Patient Name(Required)
Purpose of Referral(Required)
(fees collected directly from the patient)

Referral Requirements

The referring dentist is responsible for supplying us sufficient information to justify an appropriate exposure. Please complete all parts of this form.

2D field of view

Full
Sectional
Exposure
Patient Size

3D field of view: For CBCT referrals, if an intra-oral radiograph of the area is available, please attach it for justification purposes

8x8cm
5x5cm (sectional)
11x10cm
Exposure: Standard image resolution will be used unless you specifically request high or low resolution
Radiographic stent to be worn Radiographic stent to be worn: (to be provided by referrer)
Reporting:

Declaration: By completing below, you declare that you:

Agree and understand to the processing of your personal data as the referring clinician(Required)
Agree you have made the patient aware of this referral and the provision of their data for this purpose(Required)
• Are registered and appropriately trained to request radiographic investigation. • Will consent your patient in advance of the investigation and have informed them of the associated risk and fees involved.(Required)
• Are registered and appropriately trained to request radiographic investigation. • Will consent your patient in advance of the investigation and have informed them of the associated risk and fees involved.

Helping your patients understand referrals

Referrals can often be a confusing process for patients. The concept is new for many of them, and arranging appointments, contacting new dental practices and understanding about future care can sometimes be overwhelming. At Exeter Advanced Dentistry we want the referral process to be as seamless and as simple as possible for both you and the patient. We have created a simple 7-step process that explains the entire referral process from their perspective. Please feel free to direct your patients to this page when working with us, as it can put their mind at rest. See patient referral page.

Transparent Costs

Your patients will be given a full breakdown of our fees for any proposed treatment at the end of their consultation appointment. For further details, please view our pricing structure on this website. See our fees.

Referral Forms

At Exeter Advanced Dentistry we provide you with a choice of convenient ways to contact us regarding a referral. You can download the form, fill in the details and post the form (and any supporting documentation) to us, or simply enter the relevant details via our online form below.

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