Your dentist will interpret and use the data from your scan solely for the purpose of evaluating your upper and lower jaws for treatment planning and placement of your dental implants. It has not been read for the presence of any medical condition or pathology. You may choose to have this data examined and evaluated by a physician (radiologist) of your choosing or we can refer one to you by at your expense.
Should you desire, your dentist will provide you a copy of this scan for a fee of $400. We can also provide you a referral if necessary for a maxillofacial radiologist for this purpose. These fees typically are $150.00 payable today.
Please sign this form indicating your decision: