Queensway 3D Imagery Referral

Preferred practice

Billingham

Jesmond

Patient details

First Name *

Last Name *

DoB - Date * e.g. 30

DoB - Month * e.g. 12

DoB - Year * e.g. 1990

E-mail *

Phone *

Address *

Postcode *

Reason for referral

The clinical context for requesting a dental CBCT examination

Relevant results of history, clinical examination and other imaging

What information do you want the dental CBCT examination to provide?

Define the anatomical area that the scan(s) should cover

Medical history

Referring Dentist Details

Name *

E-mail *

Phone *

Postcode *

Address *

To comply with IR(ME)R regulations, all radiographs must be clinically evaluated to rule out the possibility of coincidental pathology. Queensway Dental does not routinely report on dental scans or x-rays; by referring for dental imaging, I (the referrer) accepts the responsibility for arranging reporting.

I understand that upon submitting the referral I will be contacted by Queensway to complete a service level agreement before the referral is processed.

For further information about how we use your data, please see our privacy policy.

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Find Us

We have practices at 5 convenient North East locations. We are a private practice with an NHS oral surgery:

Billingham

Queensway Dental Clinic Crown Buildings, Queensway, Billingham
Teesside TS23 2NU

Queensway Dental Clinic 01642 554 667

Queensway Dental Clinic reception@queensway.co.uk

Queensway Dental Clinic Opening Times

Monday: 8:00am – 7:30pm
Tuesday: 8:00am – 7:30pm
Wednesday: 8:00am – 7:30pm
Thursday: 8:00am – 7:30pm
Friday: 8:00am – 4:30pm

Queensway Dental Clinic Open in Google Maps

Jesmond

Queensway Dental Clinic 13 Eslington Terrace, Jesmond
Newcastle upon Tyne NE2 4RJ

Queensway Dental Clinic 0191 281 5976

Queensway Dental Clinic jesmond@queensway.co.uk

Queensway Dental Clinic Opening Times

Monday: 8:00am – 4:00pm
Tuesday: 8:00am – 4:00pm
Wednesday: 8:00am – 4:00pm
Thursday: 8:00am – 6:00pm
Friday: 8:00am – 4:00pm

Queensway Dental Clinic Open in Google Maps

Yarm

Queensway Dental Clinic 17A High Street, Yarm
TS15 9BW

Queensway Dental Clinic 01642 554 667

Queensway Dental Clinic reception@queensway.co.uk

Queensway Dental Clinic Open in Google Maps

Darlington

(Please note this is an oral surgery referral practice only)

Queensway Dental Clinic 293 Yarm Road, Darlington
DL1 1BA

Queensway Dental Clinic 01325 381928

Queensway Dental Clinic darlingtonreception@queensway.co.uk

Queensway Dental Clinic Opening Times

Monday: 9:00am – 5:00pm
Tuesday: 9:00am – 5:00pm
Wednesday: 9:00am – 5:00pm
Thursday: 9:00am – 5:00pm
Friday: Closed

Queensway Dental Clinic Open in Google Maps

Washington

Queensway Dental Clinic The Elms, 19 Front St, Washington
NE37 2BA

Queensway Dental Clinic

Queensway Dental Clinic Opening Times

Monday: 9:00am – 5:00pm
Tuesday: 9:00am – 5:00pm
Wednesday: 9:00am – 5:00pm
Thursday: 9:00am – 5:00pm
Friday: Closed

Queensway Dental Clinic Open in Google Maps