Referral Form – kaadentals

Online Referrals

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CBCT Referral Form

CBCT scanning services were available exclusively at the Mountain Ash location.

The patient information provided in this form will be processed securely.

Step 1. Patient Details

Patient Name

Patient Phone Number

Patient Email

Date of Birth

Step 2. Patient Details

Dentist Name

Dentist Phone Number

Dentist Email

Dentist Address

Dentist GDC Number

Step 3. Scan Details / Region of Interest

Patient to wear stent provided by dentist?

In accordance with IR(ME)R 2000, a clinical justification is required for each dental CBCT scan. Springmount Dental & Implants does not provide reporting of CBCT scans. Responsibility for the clinical evaluation and interpretation of the scan rests with the referrer and must be undertaken by a suitably trained and competent individual.

Reason for Referral and Justification for the Scan

Special Instructions to IRMER Operator Involved In Scan Acquisition

CBCT will be sent via email

File Attachments

Please include any relevant file attachment such as radiographs, clinical notes or photographs. We accept the following file: JPG, PNG, DOC, DOCX, PDF

Any Additional Comments

Reporting of Scans

I fully understand and accept that KAA Dentals does not report on the scans and radiographs requested by referring GDPs

I am the IR(ME)R referrer/operator. I am adequately trained to report on my patients scan

Dentist Declaration

I fully understand and accept that KAA Dentals does not report on the scans and radiographs requested by referring GDPs

Our Clinicians

Meet the Professionals Behind Your Smile

Every clinician at KAA Dentals is fully GDC registered, combining clinical expertise with genuine care.

Dr. Hafeez Sharief

Principal Dentist

Dr. Ajmal Fazil

Dental Therapist

Dr. Oday Hamond

Principal Dentist

Dr. Bibita Khadka

Dental Therapist

Dr. Alida Joshy

Dental Therapist

Dr. Athul Prasad

Dental Therapist

Locations

Our Clinics

KAA Dentals Locations

Mountain Ash

KAA Dentals, conveniently located in Mountain Ash at 60A Oxford Street, right beside the Post Office ATM.

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Rhymney, Tredegar

KAA Dentals is conveniently located at the Rhymney Integrated Health & Social Care Resource Centre on Lawn Terrace in Rhymney, Tredegar

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Cardiff (Coming Soon)

We are expanding! Our new location in Cardiff will be opening soon to serve you better.

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Online Referrals

Online Referrals

CBCT Referral Form

Step 1. Patient Details

Meet the Professionals Behind Your Smile

Dr. Hafeez Sharief

Dr. Ajmal Fazil

Dr. Oday Hamond

Dr. Bibita Khadka

Dr. Alida Joshy

Dr. Athul Prasad

Locations

Our Clinics

Mountain Ash

Rhymney, Tredegar

Cardiff (Coming Soon)

Follow us

Follow us

Main Pages

Mountain Ash (CF45 3HB)

Rhymney (NP22 5PW)

Cardiff CF24 (Coming Soon)

Mountain Ash

Tredegar

Online Referrals

Online Referrals

CBCT Referral Form

Step 1. Patient Details

Meet the Professionals Behind Your Smile

Dr. Hafeez Sharief

Dr. Ajmal Fazil

Dr. Oday Hamond

Dr. Bibita Khadka

Dr. Alida Joshy

Dr. Athul Prasad

Locations

Our Clinics

Mountain Ash

Rhymney, Tredegar

Cardiff (Coming Soon)

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