Refer Your Patient For CBCT

Westdale Dental Service Level Agreement for CBCT scanning

The service level agreement (SLA) for our CBCT scanning service ensures compliance with best practice guidance. This necessary agreement will allow you to refer your patients for CBCT scans.

This requires you to:

  • Confirm that you refer in accordance with published guidance criteria
  • Confirm that you have fulfilled the standard education requirements in the use of ionising radiation and radiation protection.
  • Provide certification to show that you have undertaken additional training for CBCT Referrers

Please complete and return your agreement along with copies of your relevant CPD certificates as soon as practicable so that you can start to refer patients for scans.


Our fees for the services are

  • CBCT £175
  • OPG £78.50

Please note that an additional charge of £75 (small volume) or £90 (arch or larger) will be made if a report is required by a Consultant Radiologist

CBCT Referral Form

Practice Details

Patient Details

Reason for Scan

Scan - Area of Interest

Delivery of Scan


To comply with IRMER 2000 regulations radiographs and CT scans should be reviewed by the referring practitioner or by a radiologist. This can rule out the possibility of coincidental pathology. We recommend this service and are happy to offer a report via a Consultant Radiologist.

By not ticking this box I will take responsibility to make my own arrangements.

Clinical Justification

Please Tick The Captcha Box Below Before Submitting - Thank You!

required fields marked *

Please note - this referral form should only be used for transferring information of a non-sensitive nature. If you wish to provide us with medical information or other potentially sensitive data, please contact us by telephone on 0115 9603572 and we will advise.
Powered by dB Masters Multimedia FormM@iler