Contact Us | Burton Dental Lodge

Burton Dental Lodge
156 Spilsby Road, Boston, Lincolnshire, PE21 9QP
(01205) 351 542

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There are three bus routes that provide a transport route to and from our practice: Interconnect 7/X7, Brylaine IC7, Brylaine B11/G75

ANY OTHER BUS ROUTES TO AND FROM BOSTON CAN BE FOUND ON:

https://bustimes.org.uk/operators/BRYL

Bus stops are situated at Pilgrim hospital as well as along Spilsby Road.

If you require a taxi to our practice, contact Swift Taxi’s on 01205 311123. This company can also provide a wheelchair friendly vehicle.

Address: 156 Spilsby Road, Boston,
Lincolnshire, PE21 9QP

Phone: (01205) 351 542
Fax: (01205) 351542
Email: [email protected]
Emergency number: 07491135263

CT Scan Request Form
Referral Form

CT/ OPG Scan Request Form

Patient Details
Fields marked with * are compulsory and must be filled in.
Patient Name*
Address*
Street Address State / Province / Region ZIP / Postal Code
Patient Telephone*
Patient Date of Birth*
Patient Doctor/GP*
Referring Dentist (IRMER referrer)
Referrer Name*
Referrer Address*
Street Address State / Province / Region ZIP / Postal Code
Referrer Telephone*
Referral Email*
Referrer GDC Number*
I have undertaken training required to satisfy the minimum criteria as an Irmer Referrer / Conebeam CT which is covered on pages 49, 50 and 51 of the Guidance of Safe Use of Dental Cone Beam CT (Computed Tomography) Equipment prepared by the HPA Working Party on Dental Cone Beam CT Equipment.*
Click to read guidance notes
Step 2. Scan Details
Region to be Scanned*
Patient to wear stent provided by dentist ?*
Due to the many different types of radiographic stents, it is essential that you ensure that your patient is competent in positioning it to your specifications.*
2nd scan, of stent, required ?*
In accordance with IR(ME)R 2000 a clinical justification must be provided for each CT scan and the scan must be clinically evaluated by someone trained in the analysis of dental CT scans.
IR(ME)R 2000
Reason for Referral and Justification for the scan*
Special Instructions to IRMER operator involved in scan acquisition:*
Organisation Name
Step 3. Costs
Standard CT Scan (Includes Free viewing software ICAT vision on CD ROM. (Suitable for Nobelguide if you have the Nobelguide software)
- Dental CT Scan for single tooth or sectional jaw : £150
- Dental CT Scan for both jaws : £250
- Simplant conversion one jaw : £250 (Includes cost of Scan)
- Simplant conversion two jaws : £370 (Includes cost of Scan)
- Second scan of stent for "Nobelguide" or similar : £50
- Full radiology report : £80 per Scan
- CT Scan copy (USB/CD) +£20

Referral Form

Patient Title
Patient Name*
First Last
Patient Date of Birth
Patient Address
Street Address City State / Province / Region
Patient Home Phone
Patient Work Phone
Patient Mobile Phone
Patient Email
Treatment Required(please tick all that apply)
- Prosthodontics
- Endodontics
- Radiology
- Periodontics
- Dental Implants
- Oral Surgery
- Other
Observations and Dental History
Medical History
Please tick the supporting material you will be posting us
- X-Rays
- Study Casts
- Covering Letter
Referrer Name
Referrer Email
Referrer Telephone
Referrer Address
Street Address City State / Province / Region

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