Referral FormPlease download and complete this Referral Prescription Form for your patient.  Ask your patient to bring the form when they have the ct scan completed.

CT Scans are performed at: 467 Pennsylvania Avenue, Suite 108
Fort Washington, PA USA 19034

To schedule an appointment for a CT Scan please call
215-643-5881 (Institute For Facial Esthetics)



When the oral and maxillofacial radiologist has completed the report for your patient, it will be emailed to you, the referring practitioner.  Your patient should receive their copy of the report from you.  Any discussion about findings in the report will be between the referring practitioner and the radiologist, then between the referring practitioner and the patient.  Please communicate this policy to your patient prior to their ct scan.
Thank you.