Skip to content
Scottish Centre for Excellence in DentistryScottish Centre for Excellence in Dentistry
  • Return to main website
  • Secure Forms Home
  • Service Level Agreement

  • Referral criteria for dental CBCT:

    The document specified below will be used by both parties as the basis for the referral of patients and the justification/authorisation of dental CBCT examinations:

    Entitlement of Persons

    Enter bellow the details of all persons at referring practice who will refer patients for dental CBCT examinations and/or report on dental CBCT images. The referrer holds evidence of training meeting the requirements of the HPA/BSDMFR Core Curriculum in the Dental CBCT.

    NameGDC/GMC Reg NoIRMER ROLESTRAINED 
  • Signatures of Agreement:

    We the undersigned agree: (1) to use the referral criteria stated above; (2) that evidence of adequate training has been obtained for each person named above appropriate to their IRMER roles; (3) that adequate information will accompany each referred patient to allow the justification process to proceed, as set out in the Referral form.
  • Reset signature Signature locked. Reset to sign again
  • Referral Form

  • Patient Details

  • PLEASE COMPLETE DETAILS BELOW FOR AN EXAMINATION REQUEST FOR A CARESTREAM SECTIONAL

  • Hidden
  • CARESTREAM CT REFERRAL

    • Two arch scan (8 cm x 9 cm)*—capture both dental arches in a single scan for cases that involve a larger area
    • Single arch scan (8 cm x 5 cm)—ideal for cases that require a full view of either mandible or maxilla, including implant planning with surgical guide creation and oral surgeries
    • Sectional scan (5 cm x 5 cm)—the ideal compromise of image size and dose, this mode ensures you receive the details you need, with no unnecessary information; ideal for most local dental applications
    • EndoHD sectional scan (5 cm x 5 cm; 75 µm resolution)—high-resolution mode delivers maximum precision for exams that require greater visibility of the patient’s root and/or canal morphologies; best-suited for endodontic applications
    • Pediatric program (4 cm x 4 cm)—limit patient exposure by confining radiation to a small area; a great option for younger patients, implant planning, and follow-up exams
  • ICAT Referral

  • Hidden

  • By selecting No to scan report, I understand that the CT scan is an acquisition only service and does not include interpretation

  • PLEASE NOTE: Images will be sent via email only
  • Referring Dentist's Details

  • Delivery

    CBCT will be sent via email.
  • Please include any relevant file attachment such as radiographs, clinical notes or photographs. We accept the following files: JPG, PNG, DOC, DOCX, PDF
    Drop files here or
    Accepted file types: jpg, gif, png, pdf, doc, docx, Max. file size: 64 MB.
    Copyright 2023 © Valident is a brand name of Dentsure Ltd

    You are now in a secure area

    Any data sent from this page are securely encrypted. The encrypted data are stored in an ISO27001 certified UK data centre.

    This site uses cookies. By continuing to browse the site, you are agreeing to our use of cookies.

    • Secure Forms Home
    • Return to main website