CBCT Request Form

Single jaw CBCT Scan charged at £100. The patient will be charged directly unless ortherwise requested.

Patient Details

Patient Name

Date of Birth

Phone

Email

Brief patient history and reason for scan:

Dual arch scan (additional £75)

Radiology report required (additional £100)

Refering Dentist Details

GDC No.

Email Adress

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White House Dental and Implant Centre

1 Ivy Mill Lane, Godstone

RH9 8NH

Contact Form

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