40 Alumhurst Rd, Bournemouth, BH4 8ER
Email Us
contact@onlyorthodontics.com
Contact
Call Us
01202 765808
Radiograph Referrals

If you would like us to provide this service for you, please complete the Radiograph Request Form and post it to us directly. On receipt, we will contact your patient to arrange an appointment for them.

If you require any further information regarding this service, please do not hesitate to contact us. We are happy to help in any way we can. Please note that we cannot accept referrals for cephalometric radiographs.

Download Form

  • General Dental Practitioner Details




  • Patient Details






  • Reason for Examination




  • Exposure Factor

  • Requesting Practitioner

  • This examination has been justified & authorised by:

  • Operator:

  • Any other relevant comments

  • Note: As a Referrer under the Ionising Radiation Medical Exposure Regulations 2000 (IRMER) you are responsible for providing sufficient information to allow for identification of the patient and justification of the examination. This form must contain patient name, date of birth, examination requested, clinical details supporting examination requested, surgery contact details, referrer name and signature of referrer.

  • I’d like to be informed of exclusive offers and other practice information YES

    *By clicking ‘submit’ you are consenting to us replying, and storing your details. (see our privacy policy).



contact form background image
How to get in touch

You can email us using our contact form or send an email directly to contact@onlyorthodontics.com

Call us today on 01202 765808 if you have any questions and a friendly member of the team will listen and help. Alternatively, you can message the practice on WhatsApp.

Chat on WhatsApp
  • By clicking ‘Send’ you consent to us replying, and storing your details. (see our privacy policy)
Visit the practice

Only Orthodontics, 40 Alumhurst Rd, Bournemouth, Dorset, BH4 8ER

Monday08:30 – 17:30 Tuesday08:30 – 17:30 Wednesday08:30 – 19:30 Thursday08:30 – 17:30 Friday08:30 – 17:30 WeekendsClosed

Please note that we are closed for lunch between 13:00 - 14:00

Get Directions