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CT Scan Centre - South West England

 

Dental CT Scans - Computed Tomography Scanning – CAT Scans

  

 

 
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CT Scan Referrals

layout curve

Referring Dentists or Implant Surgeons are requested to fill in all the fields.
This will enable us to respond quickly to any referral, with all the facts at hand.

Referral Form

Referring Dentist's Name
GDC No.
 
Practice name
Practice Address
Practice Postcode
Practice e-mail address
Practice Telephone
Practice Fax No
 
Patient Name
Patient D. O. B.
 


DIAGNOSTIC CT SCANNING:

Pre-Operative Diagnostic reasons? YES NO           For Implants? YES NO

Other reason please state:


SUPPLY OF SURGICAL DRILLING GUIDES: (ALL INCLUSIVE SERVICE)

Would you like us to do everything that is required to produce and deliver the Surgical Guide(s)?
YES NO If you have selected No please proceed to the next stage.

If you have selected YES then you can leave the rest to us and simply wait for the Surgical Drilling Guide(s) to be delivered to your practice address, as soon as this can be arranged. The lead time is usually 20 days.

NOTE: We supply NobelGuide ® Surgical Drilling Guides as Standard.
If you prefer another type of Surgical Drilling Guide please specify:

 


CT SCANS FOR IMPLANTS: STEP BY STEP (We always scan both arches)

Do you Require a Pre-Operative Diagnostic CT scan to assess a patients suitability?

 Tick if YES

Is a written report is required? Tick if YES (for each arch) Lower Arch Upper Arch

Is a Data CD required? (This will be supplied with the required software F.O.C.)

 YES NO
Will you make an assessment of your patient on receipt of the CD? YES NO
Shall we assess a patient’s suitability for Implants without you seeing the CD? YES NO
If we find that a patient is suitable for implant(s) what more would you like us to do?

Make a Radiological Template and take a CT scan with the Radiological Template in place.
(Radiological Templates are Custom-Made at our premises and Radio-Opaque Markers inserted)

YES NO

Send you the Data CD for you to make an assessment?

YES NO

Send the Data CD away for the Production of a Surgical Drilling Guide?

YES NO

Please state what type of Surgical Drilling Guide

 
 

If we find that a patient is not suitable for implant(s) what would you like us to do?

Wait until you have assessed a patient’s suitability after receiving the CD?

YES NO

Inform us later if you require any future involvement by us?

YES NO

 

 

 

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