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OPG Referral Form

Streamlined Referral Process for OPG Imaging Services

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Refine Patient Referrals with Our OPG Radiography Form

Experience hassle-free referral for OPG imaging services with our dedicated OPG Referral Form. Simplify the process of accessing advanced imaging solutions for your patients. Trust Coppertop Dental Surgery to provide seamless support, ensuring efficient communication and timely OPG imaging appointments for enhanced patient care.

Patient Details



Referring Dentist Details



Type Of Scan



Scan Size


Cbct Output Format


Justification For Scan


Scan Template To Be Fitted


Will You Provide Your Own Radiographic Report?


Fees (£150 Per Arch/sextant For Cbct And £45 For Opt)


Radiographs & Clinical Photographs

If you would like to attach any radiographs, clinical photographs or any documents that you feel would be of use, please use the upload facility below.


Please Note: It is the referring practitioner’s responsibility to ensure that all scans and radiographs are reviewed and reported appropriately in the clinical records, in compliance with irmer 2000 regulations.

It is strongly recommended that all scans/radiographs are reported upon by an appropriately trained individual to assess for any coincidental pathology.

Please let us know if you wish to make your own arrangements for the reporting.