OPG Referral at Treeline Dental Care
* This form is for Treeline Dental associates referring patients for an OPG. *
Please complete the patient and referring dentist details in full so our radiography team can process the request accurately. All scans are carried out in line with IRMER (Ionising Radiation Medical Exposure Regulations) requirements.
What We Need From You
Patient details
Confirmation if the patient is pregnant.
Area(s) of interest clearly indicated.
Justification for the OPG (implant planning, impacted teeth, pathology, ortho assessment, etc.).
Processing & Reports
Once submitted, the referral will be reviewed by our radiography team.
The scan will be performed at the designated Treeline site.
Images and reports will be sent back to you promptly for treatment planning.
*This service is for internal Treeline clinicians only. If you are referring externally, please use the general referral form.