Dental Referral Service at Rock Dental

Rock Dental Patient Referral Service

We offer a wide range of treatments for which you can refer your patients on to us. Many local practices use our dental referral service and facilities.

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We provide a dental referral service in the following areas:

- Dental Cone Beam Computerised Tomography (CBCT) & Reporting...

- Dental Panoramic Radiographs (OPG / OPT / DPT) ...

- Oral Surgery, Wisdom Teeth Extraction, Tooth Exposure etc...

- Dental Implantology and Bone Grafting

- Dental Conscious Intravenous Sedation

- Orthodontics (Fixed, Removable & Aligners)

- Periodontics and Gingival Surgery

- Orthograde and Surgical Retrograde Endodontics

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Working in partnership

We believe in great working relationships. We will always work in close partnership with you, the referrer. We can complement your existing services and broaden the range of treatment options available for the benefit of your patients.

Rest assured, we only treat patients for the issue they have been referred to us for. If further treatment is needed, this will not be discussed with the patient or undertaken until we have spoken to you about this. Once our treatment is completed, we will discharge the patient back to your care.

How to refer

There are many ways you can refer a patient to us.

You can fill out the online referral form below, or download the PDF referral forms at the bottom of this page and  email them to us at info@rockstaging.reidmedia.co.uk

Alternatively, please contact the practice, and we can send you a printed referral pack. You can then manually post referrals to us.

For the NICE Guidelines on referrals click here

 

Rock Dental Referral Form

Patients Title:
  • - select the patients title -
  • Mr.
  • Miss.
  • Mrs.
  • Dr.
  • Prof.
  • Other
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Patients First Name:
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Patients Last Name:
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Patients Date of Birth
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Patients Gender:
  • - select a option -
  • Male
  • Female
  • Mixed Gender
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Patients Ethnic Group:
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Patients Address:
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Patients City:
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Patients Post Code:
Enter a valid postcode
Enter a valid postcode
Patients Email Address:
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Patients Mobile Phone Number:
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Patients Phone Number:
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Patients Medical History:
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Referral Details

Please provide details of the referral below.
Dental Speciality
Please enter the area of dentistry you are referring for:
  • - select a option -
  • CBCT and OPG
  • Dental Sedation
  • Periodontology
  • Endodontics
  • Oral Surgery
  • Implantology
  • Orthodontics
  • Invisalign
  • Hygiene
  • Cosmetic Dentistry
  • Restorative Dentistry
  • Prosthetics
  • Facial Aesthetics
  • Unsure
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Field is required!
Please tick which practitioner you are referring to
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Field is required!
Please tick which practitioner you are referring to
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Field is required!
Please tick which practitioner you are referring to
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Field is required!
Please tick which practitioner you are referring to
Field is required!
Field is required!
Please tick which practitioner you are referring to
Field is required!
Field is required!
Please tick which practitioner you are referring to
Field is required!
Field is required!
Please tick which practitioner you are referring to
Field is required!
Field is required!
Please tick which practitioner you are referring to
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Field is required!
Please tick which practitioner you are referring to
Field is required!
Field is required!
Please tick which practitioner you are referring to
Field is required!
Field is required!
Please tick which practitioner you are referring to
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Field is required!
Please tick which practitioner you are referring to
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Field is required!
Please tick which practitioner you are referring to
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Please tick the service you are referring to:
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Details Of Referral
Please provide details of the case and the treatment you would like us to provide
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Field is required!
Digital OPG Referral Details
Do you require and OPG Radiograph?
  • - select a option -
  • Yes, OPG Required (£65)
Field is required!
Field is required!
Clinical Justification for OPG
Please provide your clinical justification for the requested panoramic radiograph
Field is required!
Field is required!

CBCT Scan Referral Details

Justification
I agree to use the referral criteria as per the European Guidelines: Radiation Protection No. 172 and provide adequate clinical information in order for each examination to be justified
  • - select a option -
  • Confirmed
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Field is required!
Reason for referral and clinical context
Reason for referral and clinical justification for CBCT scan? Include the clinical context for requesting a dental CBCT examination:
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Field is required!
Scan Purpose
Check all that apply
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Enter the "other" scan purpose here
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Field is required!
Imaging Stent Required?
Is the patient required to wear an imaging stent during the scan?
  • - select a option -
  • No
  • Yes and will be provided by referrer
Field is required!
Field is required!
Field of View
Enter the scan size below. Note the costs of each type of CBCT scan.
  • - select a option -
  • 8 by 8 Maxilla (£200)
  • 8 by 8 Mandible (£200)
  • 12 by 8.5 (£255)
  • 8 by 5 (£170)
  • Endodontic (£125)
Field is required!
Field is required!
Scan area
Enter a range of upto 4 teeth to be scanned for a small volume scan, or enter a single tooth to be scanned if an endodontic scan is required
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Field is required!
Information Required
What information do you want the dental CBCT examination to provide?
Field is required!
Field is required!
Additional Information
Provide any additional information or notes for the operator
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Field is required!

IRMER Reporting Regulations

Rock Dental does not routinely report upon referred scans or radiographs. To comply with the IRMER 2017 Regulations all radiographs and scans are required to be reviewed and reported into the clinical notes by the referring practitioner or by a radiologist. We strongly recommend that all CT and other radiographic examinations should be reported upon to rule out the possibility of co-incidental pathology.
Scan Reporting
Enter reporting requirements below. If you are to make your own arrangement for the reporting of the Cone Beam CT scans acquired at Rock Dental you confirm that his will be done by someone adequately trained as per HPA-CRCE-010-Guidance on the safe use of Dental Cone Beam CT
  • - select a option -
  • Rock Dental to arrange scan reporting (£105)
  • Referrer to arrange scan reporting
Field is required!
Field is required!

Regulatory Compliance Declaration

I hereby authorise Rock Dental to carry out a 3D CBCT / OPG on my behalf. When scanning guides are used, these guides will be prepared in advance by the referring dentist and given to the patient to bring to the scan appointment. The results of the scan will be returned on a disc or electronically with basic viewer software. Although a basic evaluation of the scan will be carried out on site, a radiology report will not be supplied unless requested. I am responsible for assessing the data and referring to the necessary specialities as clinically indicated. Rock Dental and the Operator will not be responsible for assessing the scan for the suitability of treatment or for ultimately identifying and referring pathology; by referring the patient, I am accepting this responsibility. The HPA CRCE-010 guidelines suggest that attendance of a CBCT Training Certificate Course is deemed a regulatory requirement for all users of CBCT systems, including those who are simply referring patients for the acquisition of a CBCT image. I accept that it is my responsibility to obtain the necessary qualification in order to refer and evaluate the data requested by me and provided by Rock Dental. Alternatively, I will arrange for a Consultant Radiologist to rule out coincidental pathology.
  • - select a option -
  • Regulatory Compliance Declaration Confirmed
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Field is required!
Estimated Service Cost
The below amount is the estimated costs of the service you have selected.
£0.00 GBP
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Field is required!
Payment
Please confirm who is responsible for payment
  • - select a option -
  • Patient to pay Rock Dental
  • Referrer to pay Rock Dental
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Has the patient been informed of the costs involved?
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File Uploads

Do you have any xrays or documents you wish to upload and send with your referral?
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Please upload your files here
Please upload your files here
Upload your documents...
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Referring Practitioners Details

Please enter your details below:
Your Title:
  • - select the your title -
  • Mr.
  • Miss.
  • Mrs.
  • Dr.
  • Prof.
  • Other
Field is required!
Field is required!
Your First Name:
Field is required!
Field is required!
Your Last Name:
Field is required!
Field is required!
Practice Name:
Field is required!
Field is required!
Address:
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Field is required!
City:
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Field is required!
Post Code:
Enter a valid postcode
Enter a valid postcode
Email Address:
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Field is required!
Mobile Phone Number:
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Field is required!
Practice Phone Number:
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Field is required!
GDC Registration Number
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Field is required!
Signature:
Please sign here to confirm all referral details are correct
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Field is required!
Submit

Referral Forms

Download our referral form.

One of our team will reach out.

REFERRAL FORM