CBCT Referral Service

Simply fill in the form below, or download and complete a pdf version.

Malmin Service Level Agreement for CBCT scanning

The service level agreement (SLA) for our CBCT scanning service ensures compliance with best practice guidance. This necessary agreement will allow you to refer your patients for CBCT scans.

This requires you to:

Confirm that you refer in accordance with published guidance criteria
Confirm that you have fulfilled the standard education requirements in the use of ionising radiation and radiation protection.
Provide certification to show that you have undertaken additional training for CBCT Referrers

Please complete and return your agreement along with copies of your relevant CPD certificates as soon as practicable so that you can start to refer patients for scans.

Referred By:

Preferred Practice

Patient Details:


Image Format


Examination Required


Region of Interest


Image Justification


e.g. specific imaging parameters / protocols / scanner preference / concern / medical history

IRMER 2000 Regulations: Malmin Dental does not routinely report upon referred scans or radiographs. To comply with the IRMER 2000 regulations all radiographs and scans are required to be reviewed and reported into the clinical notes by the referring practitioner. Malmin Dental strongly recommends that all CT and other radiographic examinations should be reported upon to rule out the possibility of coincidental pathology.

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