Tel: 0117 9238 400 Fax: 0117 9467 007 Email: info@rootfillings.com

3D CT Scan - Make a referral

Please note the referrals page is for use by the dental profession only.

Please fill in the form and click on the 'Send Referral' button to send the information electronically to us.

Click here for a printable version of the referral form.

  • Patient information

  • Dentist information

  • CT scan required:
  • CT scan charges:
  • Please indicate your preference for radiological interpretation of the dento-alveolar region:
  • Before clicking 'Send Referral', please ensure that a valid email address has been entered in the dentist 'Email' field above. This is so that we can send you confirmation that the referral has been sent.
    *required field

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