Cone Beam Scan Referral

Please fill out the information below and click "Submit". A team member will contact your patient as soon as possible.

    Requesting Doctor
    Patient Information
    Report Options

    Note: Maximum resolution by scan size is designated by color code.

    Field of View
    Voxel Size/Scan Time
    Please provide any additional details and comments here.
    Patient Expectations

    Patient will be expected to pay for service at the time the scan is obtained and a receipt will be provided. The patient and/or the referring office will be solely responsible for submission to insurance companies should patient reimbursement be desired.

    Scans are provided as a service and are not read nor interpreted by Dr. Paquette. A CD with volume (DICOM image) and native software will be mailed to referring dentist. Interpreting the scan volume is the sole responsibility of the referring doctor. Dr. Paquette strongly recommends having the volume contents read by a qualified Oral and Maxillofacial Radiologist. Interaction with prosthetic laboratory is the sole responsibility of the referring dentist. Should electronic submission to a lab be requested additional fees will apply.

    (Dr. Initials)