Dental CT Scan Referral in Glasgow

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TSB HOUSE, 238 Ayr Rd, Newton Mearns, Glasgow, G77 6AA

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TSB HOUSE, 238 Ayr Rd, Newton Mearns, Glasgow, G77 6AA

Call 0141 280 2193

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Call 0141 280 2193
book appointment

Radiograph Referrals

OPT £99, CBCT Scan £299

Dentist Name *

Dentist GDC No

Dentist Email *

Dentist Telephone

Dentist Address *

Patient Details

Patient Name *

First

Last

Patient DOB (DDMMYYYY) *

Patient Email *

Patient Telephone

Patient Mobile

Patient Address

Referring Details

Type of referral *

CBCT Scan
OPT

Please tick all boxes that apply

Reason for referral and justification for CBCT scan

CBCT scan area of interest

Maxilla
Mandible
Both
Small Section

Reason for referral and justification for digital OPT

OPT area of interest

Left Side
Right Side
Full Mouth

X-rays/Any other relevant files enclosed? *

Yes
No

Please attach all relevant files:

Drag & Drop Files, Choose Files to Upload

Does the patient require a consultation with Dr Areeb Anwar along with the Radiograph? *

Yes
No

Any relevant medical history? *

Yes
No

Please list all relevant history:

Has the patient been referred before? *

Yes
No

Please indicate your preference for radiological interpretation of the dento-alveolar region: *

Please supply a Consultant Radiologist report (£200)
I undertake to report on the scan myself as required by IR(ME)R 2000/2006

Name

Dentist in Newton Mearns, Glasgow

Providing 'Smiles' Is Our Speciality

teeth straightening Dental Implants Cosmetic Dentistry facial aesthetics

Want to get in touch? We’d love to hear from you.

TSB HOUSE
238 Ayr Road
Newton Mearns
Glasgow, G77 6AA

Directions

E-mail

info@smileglasgow.com

phone

0141 280 2193

Opening Hours

Monday	9:00 AM - 5:30 PM
Tuesday	9:00 AM - 5:30 PM
Wednesday	9:00 AM - 5:30 PM
Thursday	9:00 AM - 5:30 PM
Friday	9:00 AM - 5:30 PM
Saturday	Closed
Sunday	Closed

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Online Store
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