Referrals

Referrals for CBCT Scanning, Oral Surgery & Dental Implants

Referrals

We offer a referral option for the following services:

  • CBCT Scans/Digital OPG’s
  • Oral Surgery
  • Dental Implants

Individuals seeking treatment are also welcome to contact us directly, or ask their current dentist for a referral.

DENTISTS CAN REFER A PATIENT TO US IN SEVERAL WAYS:

Online: By completing our referral form below.

By Letter: Clarence Dental Practice, 21A Clarence Street, Staines-upon-Thames, TW18 4SU

By Email: info@clarencedentalpractice.co.uk

Referral Form

Referring Dentist Contact Details





Patient Information







Referral details

Type of referral




If you are requesting a CBCT Scan please complete the CBCT scan details section below

CBCT scan request details

1. Please confirm you hold evidence of training meeting the requirements of the PHE/BSDMFR Core Curriculum in Dental CBCT to allow you to refer for CBCT scans

 
   

2. Please confirm you have received the required training to report on CBCT scans

 
   

If you have answered ‘No’ to question number 2, please tick the box to request a report


 

How would you like to receive your scan?

 
   

Which format would you prefer?

 
   
   

Which jaw do you require?

 
   
   

5x4cm scan of local area





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Clarence Dental Practice in Staines upon Thames

Practice was established in 1988

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