Dental CT Scan and OPT Referral Form

    Patient Details








    Referring Dentist Details






    Treatment Details



    Radiographs






    Dicom files for the scan together with diagnostic and planning software will be delivered to the referring dentist on CD.

    Moss Osman of Bridge Dental Clinic does not report upon scans and radiographs on behalf of referring dentists. To comply with the IRMER 20000 regulations all radiographs and scans are required to be reviewed and reported into the clinic notes by the referring practitioner or by a radiologist. We strongly recommend that all CT and other radiograpih examinstaions should be reported upon to rule out the possiblility of coincidental pathology.

    Moss Osman of Bridge Dental Clinic offers a reporting service by a Consultant Radiologist (Please tick below).


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