OPG Referral | Tunbridge Wells & Brighton

Tunbridge Wells:01892 616062 Brighton:01273 553317

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We are happy to accept referrals for OPG scans in Tunbridge Wells and Brighton and Hove. Complete the below form and a member of the team will be in touch with your patient to book them in and keep you updated every step of the way.

Prefer to send your referral? Download our referral form to print and send to your chosen practice.

OPG Referral in Tunbridge Wells & Brighton

Referrer Details

Clinician Name *

GDC Number *

Email Address *

Phone Number *

Referring Practice *

Street Address

House / Flat Number

City

State/Province

Post Code

Country

Patients Details

First Name *

Last Name *

Phone Number *

Email Address *

DOB *

Street Address

House / Flat Number

City

State/Province

Post Code

Country

Location

Is the patient possibly pregnant *YesNo

Relevant Medical and Dental History *

If 'Other' please specify

Need to submit another type of referral? Please find additional referral forms below:

Dentist Referral Form

CBCT Referral Form

Referrer Details
Clinician Name *
GDC Number *
Email Address *
Phone Number *
Referring Practice *
Street Address
House / Flat Number
City
State/Province
Post Code
Country
Patients Details
First Name *
Last Name *
Phone Number *
Email Address *
DOB *
Street Address
House / Flat Number
City
State/Province
Post Code
Country
Location
Is the patient possibly pregnant *YesNo
Relevant Medical and Dental History *
Justification for X-ray *Implant Treatment PlanningOrthodontic AssessmentImpacted Teeth AssessmentEndodontic AssessmentTMJOther
If 'Other' please specify
PRIVACY POLICY *
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OPG Referral Form

OPG Referral in Tunbridge Wells & Brighton

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