Aj Dental

Dental CT Scan or OPG Referral Form

ct scan potters bar

Dentists - Please Fill-in the Form

*In-house CT Scanner at AJ Dental Care in Potters Bar. CT Scan & OPG Hertfordshire Referrals.

AJ Dental Care: 28 Barnet Rd, Potters Bar, EN6 2QU
Tel: 01707 524 442

Our Fees:
CBCT: £95
OPG: £45

Referring Practitioner / Clinic Details
Patient Details
Examination Required (CBCT or OPG?)
Area of Interest (CBCT Only)
Who is Paying for the Scan?

Please Sign Below by Retyping Your Name