CBCT scanning service booking form for referral dentists and doctors
Key information for first time users:
If this is the first time you have used our CBCT scanning service please print off our PDF version, complete and return a copy our CBCT service level agreement. Please read the HPA working party’s guidance on the safe use of dental CBCT equipment.
The information you provide here will be used solely for the purpose of completing the CBCT scan. A patient record will be created within our secure patient management system and a copy of this form scanned and added to patient notes.
We will not share any information provided above with any third party unless explicitly requested to do so in writing either by you the referring GDP/GMC, or the patient.
Find out more information about how we protect your data and that of your patients.
- On submission you will receive a copy of this completed form via email. Please keep for your records.
- A member of the Arnica team will then contact your patient to arrange an appointment and if they are paying for the CBCT scan a payment will be taken.
- You will be notified of the appointment date and time.
- You will be notified when the scan is complete.
- A copy of the scan will be posted to you via recorded delivery on an Arnica USB stick.
To ensure that we are not caught out by the occasional technical glitch, if a member of the Arnica team has not contacted you within 48 hours (two working days) of completing this form please call us on 01242 655554.
Please note: Failure by the patient to attend an appointment will incur a £50 non-attendance fee. If you require any further information about our CBCT scanning service or need assistance with completing this form, please call 01242 655554 and speak to a member of the team.
