Fresno Dental Scan
3D Dental Services and Cone Beam Dental Scans in Fresno, CA
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Patient Referral Form
CBCT Patient Referral Form
*
Referring Doctor's Name
Please enter referring dentist or physician's name
Referring Doctor's Email Address
CBCT data set will be send to this email address through a HIPPA compliant system
*
Patient's phone number
Please enter patient's phone number
*
Cone Beam CT Scan
Yes
No
$299 service fee
*
Digital Implant treatment planning?
Yes
No
Do you require digital implant treatment planning? $199 additional fee
*
UCLA Radiology Report
Yes
No
The additional cost for this service is $699 for 3-4 days turnaround or $899 for a rushed report delivery