Digital Imaging – CBCT Referrals

Our practice utilises state-of-the-art Planmeca ProMax 3D Classic CBCT scanners. If you would like to refer your patients for digital imaging, we have plenty of options to choose from that keep radiation to a minimum.

Depending on your requirements, the area of the scan can be limited to 50 x 50mm for local planning, 80 x 50mm for full arch, or 80 x 80mm for both maxillary and mandibular arches. We can send the scan results to you by password-protected memory stick or through a secure cloud hosting service.

Please note that Queensway Dental does not offer a CBCT reporting service. The fee for an unreported CBCT scan is £200.

Legal requirements

The Health Protection Agency requires a service level agreement between the CBCT practice and referring practice. Before we can accept referrals, an agreement will be required outlining the training of the referring practitioner and to ensure requests are justified.

The prescribing dentist is required to have undertaken ‘Core Training in CBCT’ as outlined in the HPA-CRCE-010 report.

Fields marked with * are required.

Preferred practice

BillinghamJesmond

Patient details

First Name *

Last Name *

Date of Birth *

Day (e.g. 30)

Month (e.g. 12)

Year (e.g. 1990)

E-mail *Please enter a valid email address.

Phone *Please enter a valid phone number.

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 *

Phone *

E-mail *Please enter a valid email address.

Postcode *

Address *

Declaration

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) accept the responsibility for arranging reporting.

This field is required.

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

This field is required.

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

Find Us

Our dentists care for patients across the North East, at eight convenient locations from Newcastle to Middlesbrough. We are a private practice with an NHS oral surgery.

Queensway Dental - Billingham

Crown Buildings, Queensway, Billingham, Teesside TS23 2NU
01642 554 667
reception@queensway.co.uk
Monday – Thursday
8:00am – 7:30pm
Friday
8:00am – 4:30pm

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