X-ray referral

Name: Sussex Orthodontics
Telephone: 01243 682 027

If you need to refer your dental patients for X-rays at our practice, please fill out our referral form below:

Please fill in all fields marked with *

Name*

Practice Name*

Email*

Phone*

Referral Type Private Patient

Name*

Phone*

Date of Birth

Address*

Email*

Possibility of pregnancy Yes No

Examination required Dental Panoramic Lateral Cephalogram CBCT

I will make my own reporting arrangements

Comment*

For further information about how we use your data, please see our privacy policy

Visit Us

Come and see us in Bognor Regis - we’re easy to find, always happy to help, and ready to chat about your smile.

60-62 London Road,
Bognor Regis
West Sussex PO21 1PT

Opening Times

Weekends - we are always contactable via the Dental Monitoring app!