CT Scan Referral Form

All scans cost £200 each.

  • Patient Details

  • DD slash MM slash YYYY
  • Referring Dentist Details

  • DD slash MM slash YYYY
    When scanning guides are used, the guides must be prepared in advance by the referring dentist and given to the patient to bring to the scan appointment.
  • Raw DICOM scanning data will be returned to you via CD with a basic viewer software. You can then send the scan to CGI for formatting into SimPlant, however you will be responsible for costs incurred. See price list. Please note: The results of the CT data will not be medically evaluated by The Implant Centre – you are required to do this and to treat your patient according to your findings.
  • Please confirm that you have read and agree to the following

    Data Processor Contract for Associate Dentists (EU)

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