Get Cbct Scan Referral Form

Filling out the CBCT scan referral form online is an essential process for healthcare providers to ensure accurate imaging for their patients. This guide will walk you through each step, making the online submission straightforward and efficient.

Follow the steps to complete your CBCT scan referral form online.

1. Click ‘Get Form’ button to access the CBCT scan referral form and open it in your preferred editor.
2. Begin by entering the patient name in the designated field. This information is crucial for identifying the patient in the system.
3. Next, input the patient’s date of birth (DOB) in the provided format. This helps in verifying the patient's age.
4. Fill in the patient’s contact phone number, ensuring accuracy to facilitate communication.
5. Proceed to enter the referring doctor’s name and ensure that all contact details, including address, city, state, ZIP code, phone, fax, and email, are correctly filled out.
6. Select the appropriate CBCT scan options based on the patient's needs. Indicate if it is for guided surgery, endo, TMJ, or post-op, and specify upper, lower, or both if applicable.
7. In the case of edentulous or nearly edentulous implant patients, confirm whether they have a conventional scanning appliance by selecting ‘Yes’ or ‘No’.
8. For implant or endo cases, check the corresponding tooth location to provide precise information.
9. Review the option concerning radiology reports. If the referring doctor chooses to decline the radiology report, they must check the corresponding box and acknowledge their acceptance of full responsibility for the diagnosis.
10. Finally, the referring doctor must sign the form and include their license number before submission.
11. Once all sections have been completed, save changes, download, print, or share the CBCT scan referral form as necessary.

Take the first step in patient care by completing your CBCT scan referral form online today.