Get Tufts University Cone-beam Computed Tomography (cbct) Referral Form 2017-2025

This guide provides clear and comprehensive instructions for filling out the Tufts University Cone-Beam Computed Tomography (CBCT) Referral Form online. By following these steps, users can ensure that all necessary information is accurately submitted for diagnostic imaging services.

Follow the steps to complete the referral form online.

1. Press the ‘Get Form’ button to access the form and open it for editing.
2. Begin with the referring dentist information section. Fill in the name and department of the referring dentist. Provide their telephone number and fax number.
3. Complete the mailing address by entering the street, city, state, and zip code for the referring dentist.
4. Move to the patient information section. Enter the patient's name and date of birth. If available, provide the patient’s Axium number.
5. Fill out the home address for the patient, including the street, city, state, and zip code.
6. Input the patient's telephone numbers in the respective fields for home, work, and cell.
7. In the CBCT requested section, select the appropriate option(s) for the CBCT request, including specifics about implants, the area of focus, and any relevant fees.
8. Provide any clinical information, diagnosis, or additional details that might assist the maxillofacial radiologist.
9. Review all the information for accuracy to ensure that all necessary fields are completed.
10. Once all sections are filled out, users can save the changes, download, print or share the completed form.

Submit your completed Tufts University CBCT Referral Form online today.