OPT & CBCT Referral Form

Please note: For first time referrals please complete the SLA linked below and attach it to your referral form. This only needs to be completed once for each practice and referring dentist unless any changes are made.

Referrer Details

Patient Details

Upload any necessary documents or radiographs (for first time referrers, please download and complete the SLA and attach here)

Upload File

Radiograph Required
OPT - £50
CBCT - £150

Required Radiograph:
Payment:
For those who have already submitted an SLA previously:

Thanks for sending your referral! We will be in touch soon