Cone Beam Scan Referral

Please correct the errors described below.
Month / Day / Year

1. Type of Imaging:

Implant Measurements Required:

Please note if you require two quads, UL/LR or UR/LL is a 4 quad scan.

Click on a number and write additional comments under "More Information" if needed.

3. Imaging Required For:

Delivery method: Please note we require 2 week turnaround for reports

Please email or fax us a copy of this referral along with giving your patient a copy. Thank you.

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