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7676655430
ngoscans91@gmail.com

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Referral Form

Patient Details

Doctor Details

2D Imaging Services

OPG / Panoramic Lateral Ceph TMJ Hand Wrist PNS View PA View AP View SMV View Reverse Towne’s View

3D Imaging Services (CBCT Scanning)

Scan Region

Single Tooth Quadrant Maxilla Mandible Full Mouth TMJ RT LT Airway Evaluation

Mark Teeth of Interest

Scan Purpose

Pre-Implant Scan Virtual-Implant Planning Post-Implant Scan Endo Evaluation Perio Evaluation Periapical Pathology Impaction Supernumerary Tooth Cyst / Tumor Jaw Fracture Ortho Evaluation Airway Evaluation Malignancy Other Pathologies, please specify.................................

Report Format

WhatsApp / Email CD Paper Print DICOM Files Normal Reporting (48 Hrs)

Express Reporting (24 working hours)

Additional charges apply
Contact us for more details

Patient Signature

Doctor Signature

Timings: Monday – Saturday 9:30 AM - 9:00 PM
Sunday: 9:30 AM – 1:00 PM

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Our Services

CBCT
- 2D Imaging
- 3D Imaging

Contact Us

#2230, C Block, D Group, Muddinapalya Main Road, Behind Hotel Ashwa, Gidadakonenahalli, Nagarbhavi, Bengaluru – 56009, Karnataka

7676655430

ngoscans91@gmail.com

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