Download Referral Form
Clayray Dental Radiology
Farrer House
F  03 9650 5356

How to refer CBCT’s

You can refer as long as you are a registered dentist/specialist/doctor with a registered provider number.

We have included common examinations for you to select from on our request form. All you need to do is

1. Tick/Circle the Cone Beam CT examination that suits the nature of your treatment/investigation (eg: if you’re looking at impacted teeth, supernumeraries and so forth you would select “Ortho survey”).

2. Circle the tooth,teeth or area of interest.

3. Some clinical notes would be nice. You can also specifiy what it is you are looking for exactly; a missed root canal, resorption on a particular tooth, and so forth.

3. Sign, date and include your provider number (and clinic address/contact details if it is your first time referring) on the request form. You can download the form here.