01242 655554

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 booking form please click below to view key information for form users.

Click here for key information about the CBCT Scanning Service

CBCT Service Level Agreement

If this is the first time you have used our CBCT scanning service please download, read, sign and return to us our CBCT Service Level Agreement (SLA).

To download a copy of our CBCT Service Level Agreement click on the CBCT SLA in the sidebar (arrow pointing right) or go to our Referral Service page and download a copy from there.


Data Protection

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.

For more information about how we protect your data and that of your patients please see
our Privacy Notice on our website www.arnicadentalcare.co.uk/privacy-notice.


What Happens Next

On submission you will recieve 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 either added to dropbox and shared with you or if requested a copy will be posted to you via recorded delivery on an Arnica USB stick


Technical

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 (2 working days) of completing this form please call us on 01242 655554


Notice for Patients

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 assistance completing this form please call 01242 655554 and speak to a member of the team.