Imaging Referral Form

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Referred By:

In accordance with guidance issued by the European Commission, we have adopted the latest best practice which requires dentists who refer patients for CBCT scanning to have a service level agreement in place with their chosen CBCT scanning referral centre.

Please complete and return your agreement along with copies of your relevant CPD certificates as soon as practicable so that you can start to refer patients for scans. Please also complete and return a patient CBCT referral form outlining all of your requirements.

Patient Details:
Possibility of Pregnancy
Is the patient coming with a radiographic template?
RADIOGRAPHIC EXAMINATION REQUIRED (please tick one)
Examination part 2
FORMAT DATA DELIVERY OPTIONS FOR CT SCANS
PAYMENT

All imaging service fees must be paid before the patient appointment is booked.

Buckden Dental Clinic does not routinely report upon scans and radiographs. To comply with the IRMER 2000 regulations all radio-
graphs and scans are required to be reviewed and reported into the clinical notes by the referring practioner or by a radiologist.

Buckden Dental Clinic strongly recommends that all CT and other radiographic examinations should be reported upon to rule out the
possibility of coincidental pathology. Buckden Dental Clinic offers a reporting service by a Consultant Radiologist.

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IMAGING AT BUCKDEN DENTAL CLINIC

All imaging appointments are to be booked through our reception team. Your radiographic and CT examinations take
place in our ground-floor, dedicated Radiography / Acquisition suite. Imaging results are available immediately for
radiography or CT scans, unless the image is to be sent for specialist reporting.
Please allow 30 minutes for your examination.

OPENING HOURS

• Our opening hours are Monday to Thursday 9am to 5pm. Friday 9am to 3.20pm.
Saturday and evenings by appointment only.
• We accept all major credit cards and cash.
• All imaging service fees are due at the time of the appointment.
• Your dentist may ask you to wear a plastic guide during your scan – please be sure to bring this along.

3D SCANNING OF THE JAWS

Our high resolution 3D scanner is a new generation Cone Beam CT scanner, specifically intended for examination of the
jaws and skull. The scan time may be as little as 10 seconds, and the patient is examined in a seated position rather than
lying down, so patient comfort is much improved.
The scans set a new standard in planning for Dental Implant Surgery, Oral and Maxillofacial Surgery, ENT Surgery,
Endodontics, Periodontics and Orthodontics.
This data can also be processed by our sophisticated software to identify and select a particular anatomical region.
We can then view this as a high resolution 3D image.

2D PANORAMIC RADIOGRAPHY

This examination produces a 2D image of all your teeth and jaws (including buried teeth), and is useful for planning
Dental Treatment, Orthodontics, Oral Surgery, or simple Dental Implant Surgery.

OPENING HOURS

Monday 9:00 AM - 1:30 PM
2:30 PM - 8:00 PM
Tuesday 9:00 AM - 1:30 PM
2:30 PM - 5:00 PM
Wednesday 9:00 AM - 1:30 PM
2:30 PM - 5:00 PM
Thursday 9:00 AM - 1:30 PM
2:30 PM - 5:00 PM
Friday 9:00 AM - 3:20 PM
Saturday 9:00 AM - 1:00 PM
Sunday Closed

NOTE: Closed Mon/Thurs – 1.30pm- 2.30pm.
Saturdays & Evenings by Appointment