OPG Referral

Dentists please complete the form below if you wish to refer patients to dentalessence for an OPG scan.

We will reply to your request as soon as we can.

Your Practice Details (please ensure this section is fully completed)

* Indicates required field

Patient Details

Justification for scan (IRMER 2000)

Orthodontic assessment and planningImpacted teeth assessmentEndontic assessmentTMJ assessmentImplant treatment planning
(assessment of position of anatomical
structures, bone quality and quantity)

To be completed by the referring practitioner

This will act as the practitioner’s electronic signature: I hereby authorize dentalessence to carry out an OPG on my behalf.

The results of the scan will be returned via email or on disc. I am responsible for assessing the data and referring to the necessary specialties as clinically indicated.

dentalessence and the Operator will not be responsible for assessing the OPG for the suitability of treatment or for ultimately identifying and referring pathology; by referring the patient I am accepting this responsibility. The HPA CRCE-010 guidelines suggest that attendance of Radiology Training Courses are deemed a regulatory requirement for all users of radiographs, including those who are simply referring patients for acquisition of an OPG. I accept that it is my responsibility to obtain the necessary qualification in order to refer and evaluate the data requested by me and provided by dentalessence. Alternatively I will arrange for a Consultant Radiologist to rule out coincidental pathology.

Dentist Referrals

We also provide the following services on a referral basis.
Please click on the links below for the individual referral forms.

CBCT Referral Form
Hygienist Referral Form
Implant Referral Form
Oral Surgery Referral Form