Junction Dental, the perfect stop

Junction Dental Patient Referral Form

Junction Dental Patient Referral Form

At Junction Dental we offer referrals for patients requiring a CBCT scan or an OPG. All information will be sent back to the referring Dentist immediately following the scan via a secure dropbox link.

Our team can provide in-depth CBCT referrals which include a full CBCT report that will enable the referring Dentist to fulfill their CBCT reporting requirement in accordance with GDC legislation and good practice recommendation on request.

Dentist Details

Patient Details

Reporting of Scans

Please check to confirm the following details: 

Reporting Of Scans

Scans

Images are shared via Dropbox please make sure we have got your correct email address. 

Scan Type
Scan Size
Scan Jaw
Scan Resolution

Payment

We will take payment from the patient at the time of their appointment. However if the patient states that the Dentist is to cover the cost without our prior knowledge, we will contact the practice for confirmation before the scan is taken.