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The-Smile-Suite-Award-Wining-Orthodontics Welcome to our
luxurious specialist, implant & referral centre

To best protect the safety of our colleagues and patients during the current outbreak of COVID-19, we have taken the decision to suspend all but emergency dental care across our dental practices.

That means if you have a routine appointment at a {my}dentist practice in the coming weeks it will unfortunately need to be cancelled and we will contact you to arrange an alternative date.

If you are experiencing a dental emergency, such as severe dental pain, please call your local practice who will advise you what to do.

Your safety, and that of our team is our top priority, so please do not attend practices in person for any reason unless you are asked to do so.

Imaging referral form:

Patient details:

dd/mm/yyyy

Patient address:

Referring dentist:

Dentist address:

Radiographic Examination Required:

Choose
For Cone Beam CT image please tick one of the following boxes:

Describe Region of Interest / Purpose and Justification for Examination:

Cone Beam CT Data Format:

Choose one

Payment

Choose one
The SmileSuite does not routinely report upon scans and radiographs for patients who are referred to us for dental imaging. To comply with IRMER 2000 regulations all radiographs and scans are required to be reported by the referring practitioner or by a radiologist.