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CT-Scan Referral Form

Please fill in the form below to provide information about the CT Scan Referral.

Confirm Irmer Referrer Training *
Region to be Scanned *
Patient to wear stent provided by dentist ? *
Due to the many different types of radiographic stents, it is essential that you ensure that your patient is competent in positioning it to your specifications. *
2nd scan, of stent, required ? *
Confirm image only *
Radiologist report needed *
Treatment Costs *
NOTE : CT-Scan files will be given to the patient on a CD with the required viewing software.
Acceptance *

Our Five Promises to You

We answer the phone quickly

We give you quick appointments

We give you good, honest advice

We strive to provide pain-free dentistry

We support your oral health journey

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Kidbrooke Village Dental Surgery is the trading name of Smile 4 U (Kidbrooke) Limited. Smile 4 U (Kidbrooke) Limited is a company registered in England and Wales with company number 15274995.

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Opening Hours
  • Monday
  • Tuesday
  • Wednesday
  • Thursday
  • Friday
  • Saturday
  • Sunday
  • 09:00 - 5:30PM
  • 09:00 - 5:30PM
  • 09:00 - 5:30PM
  • 09:00 - 5:30PM
  • 09:00 - 5:30PM
  • Closed
  • Closed
Weekends by appointment only

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Website Last Updated: 28 Aug 2025

Website by: Find Me Local

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