This online Cone Beam CT Scan Booking Form is for referring dentists’ use only.
Information you enter here including patient contact details is secure and will be used solely for the purpose of booking a CBCT scan. Please see data protection notes below
If this is the first time you have used our CBCT scanning service please take the time to read our service terms and conditions and health and safety compliance.
You will automatically receive a copy of this form via your designated email.
If you require any further information or help in relation to completing this form please call us on 01242 655554
Fields marked with an * are required
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
CBCT Booking Form
This website is secured via SSL so that the information you enter here is transferred to us securely via encrypted email. On receipt of this form we will then create a patient record within our EXACT patient management system and upload any radiographs you have attached as well as a scan or PDF version of this form. All other copies are then deleted.
We will not share in full or in part any information provided above with any third party unless explicitly requested to do so in writing by either you – the referring GDP, or the patient.
For more information about how we protect your data and that of your patients please see our Privacy Notice (link to privacy notice)