CBCT/OPG Referral

You can make a CBCT-OPG referral by completing the online form below. However, if you would prefer, please feel free to give us a call on 020 8391 9222, email us at reception@hortondental.co.uk.

Patient Details

Patient First Name

Patient Last Name

Date of Birth

Patient Email

Patient Address

Contact Number

Referring Dentist Details

First Name

Last Name

GDC No.

Dentist Email

Dentist Telephone

Practice Address

Type of Scan

Please select a type of scan:

Scan Size

Please select scan size:

CBCT Output Format

Please select format:

Justification For Scan

Justification for Scan

Scan template to be Fitted

Scan template to be fitted:

Will you provide your own Radiographic Report?

Your own report?:

Fees (£125 per arch/sextant for CBCT and £50 for OPT)

Who will pay for scan?:

For Scan 4X6

For Scan 8X6

Radiographs & Clinical Photographs

If you would like to attach any radiographs, clinical photographs or any documents that you feel would be of use, please use the upload facility below.

Files Upload

Choose File(s)

Please Note: It is the referring practitioner’s responsibility to ensure that all scans and radiographs are reviewed and reported appropriately in the clinical records, in compliance with IRMER 2000 regulations. It is strongly recommended that all scans/radiographs are reported upon by an appropriately trained individual to assess for any coincidental pathology. Please let us know if you wish to make your own arrangements for the reporting.

General Dentistry

Cosmetic Dentistry

Implant & Specialist Dentistry