Form - OPG Referral - Wooding Dental Group

OPG Xray Referral

Fill in all of the relevant fields and click submit to complete your referral request.

Fees include:

OPG XRAY: £45

Full name

Date of birth

Address (with postcode)

Contact number

Email address

Clinical reason for referral. Please detail reason for referral and any relevant history – including any complicating patient factors.

Additional information - medical history, medication(s) or allergies.

Referrer details - Name, GDC number, practise address, telephone number & email address.