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Dental
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1
Study type and Image Upload
2
Patient Details
3
Clinical Details
4
Case Details
Study Type
(Required)
Study Type
X-Ray OPG - $39.00 AUD / £23.95 UK / €27.00 EUR / $32.00 USD
Cone Beam CT - $178.00 AUD / £107.00 UK / €119.00 EUR / $143.00 USD
Report Delivery
(Required)
Report Delivery
Routine (24hrs)
Medically Urgent (4hrs)
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Accepted file types: jpg, jpeg, bmp, tif, zip, dcm, Max. file size: 660 MB, Max. files: 20.
Patient First name
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Patient Last name
(Required)
Title
Title
Mr
Mrs
Miss
Ms
Dr
Patient DOB
(Required)
DD slash MM slash YYYY
Patient address
I have obtained the above patient's signed consent to x-ray and send the study to PRO for reporting.
(Required)
Yes
No
Clinical Details
This Case
Date of Study
(Required)
DD slash MM slash YYYY
Practice Location
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Referring Practitioner
Report Delivery
Report Delivery
Email
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Total
Dental quantity
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