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  • Crossbank Dental Care Referral Form

  • Patient details

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  • Type of referral

    Please tick as appropriate
  • For you to be able to refer for a Cone Beam CT Scan you will need a Service Level Agreement with Crossbank Dental Care, this can be arranged by contacting our Treatment Coordination Team at tco@crossbankdental.com or 01539 720820.

     

    The below fields MUST be completed if you have selected a referral for radiograph.

  • Browse Files
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  • Dentist details

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