CBCT Referral Form

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Name of Patient
Please Confirm Agreement To Terms and Conditions Below
Referred By:

Standard Terms and Conditions

  • Iconic Smiles (“IS”) is a trading name of Experdental Ltd, a company registered in England and Wales under registration number 08621454 and whose registered office address is 310 Harrow Road, Wembley, HA9 6LL.

  • Printed reports, 3D reconstruction services, custom 3D reconstruction services, panoramic reconstructions, nerve segmentation, data networking, and any other services provided by IS are delivered “as is” without warranty, express or implied, statutory or otherwise, as to any matter whatsoever, including without limitation, merchantability and fitness for a particular purpose. IS makes no warranty as to the sufficiency or suitability of said services and does not warrant the accuracy, completeness, or correctness of the services. The results must be verified by a medical doctor to ensure accuracy before being used and compared to the medical images provided to the company. In no event will IS be liable to anyone for actions taken in connection with the use of said services.

  • IS endeavours to provide the highest quality results. However, IS will not accept any liability for incorrect or incomplete information on the Booking Form, or inappropriate or inadequate patient preparation, which may compromise the value of the final results or result in a refusal to take the CBCT.

  • IS endeavours to dispatch the final images to the referring dentist/surgeon as promptly as possible. However, equipment malfunction or pressure of other work may introduce delays. IS reserves the right not to accept referrals in such cases.

  • IS will not accept any liability for consequential losses arising from delays, whether due to late or non-payment, non-receipt of a Booking Form, pressure of other work, or for any other reason.

  • IS suggests that you do not schedule an appointment to discuss the results with your patient until you have received the results from us.

  • IS cannot guarantee that computer-readable images will be compatible with your computer system.

  • Please note that under the Ionising Radiation (Medical Exposure) Regulations 2017 (IR(ME)R 2017) and the Ionising Radiation (Medical Exposure) (Amendment) Regulations 2024, a clinical justification must be provided for each dental CT scan. IS provides dentists/surgeons with Referral Forms which can be used for this purpose.

  • IS accepts referrals from registered dental surgeons only.

  • IS does not provide a report on CBCT scans as a matter of standard procedure. The prescriber accepts responsibility for making arrangements for all radiographs and CBCT scans to be interpreted and reported on. IS cannot arrange for scans and x-rays to be reported on by a consultant radiologist. In accepting responsibility to report on scans and x-rays, the prescriber is also accepting the responsibility to ensure that they are competent and adequately trained to do so, and that their training remains current.