Make a CBCT referral

Make a CBCT/OPG referral

To refer a patient to Malvern Hills Dental, please complete and submit the form below.

Include all relevant clinical details for this case.

Once reviewed, our team will contact the patient to introduce ourselves and arrange their appointment. We will keep you fully updated throughout the process. Please note that we do not provide reporting on completed scans.

Referring Dentist Details
Patient Details
Confirmation of IRMER Referrer Training

I have undertaken training required to satisfy the minimum criteria as an IRMER Referrer / Conebeam CT which is covered on pages 49-53 of the Guidance of Safe Use of Dental Cone Beam CT (Computed Tomography) Equipment prepared by the HPA Working Party on Dental Cone Beam CT Equipment.

Scan details / Reason
Patient to wear stent provided by dentist? *

In accordance with IR(ME)R 2000 a clinical justification must be provided for each dental CBCT scan and the scan must be clinically evaluated by someone trained in the analysis of dental CBCT scans.

Reason for referral and justification for the scan *

In accordance with IR(ME)R 2000 a clinical justification must be provided for each dental CBCT scan and the scan must be clinically evaluated by someone trained in the analysis of dental CBCT scans.

Special Instructions to IRMER operator involved in scan acquisition *

Images will be reviewed and findings recorded by an IRMER operator/reporter who has undertaken the appropriate training and is up to date within their CPD cycle *