CBCT Imaging Service - Forms


For Referring Doctors


Please fill out the CBCT referral form and fax it to 734-615-4784 or send it with your patient.


For Patients

You will need a CBCT referral form provided by your referring doctor (see referring doctor section above). Please either bring it with you or make sure that your doctor sends it to us prior to your appointment.

Please fill out the health history form and bring it with you.