OPG Referral

The following form is for another dental practice to request a private Orthopantomogram X-ray (OPG) appointment to be made at Wedgwood House Dental Practice (WHDP). 

It is not to be used by a member of the public directly requesting an OPG for themselves. It is not to be used for changing an existing appointment. Should you wish to discuss appointments, please call the dental reception team on 01449 771 700. 

Failure to attend a booked OPG referral appointment will result in result in a fine to the same value of the OPG fee.  
See WHDP's booking policies.

Thank you.
 

Wedgwood House Dental Practice
100 Bury Street
Stowmarket
IP14 1HF

Phone: 01449 771 700

OPG Referral Form

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I am over 18 years of age and a UK citizen. I hereby agree that my & the patient I am medically in charge of, personal data entered in this OPG Web Ref Form will be stored electronically by Wedgwood House Dental Practice and will be processed for the purpose of taking an Orthopantomogram x-ray (OPG x-ray) and sharing the results as needed. I am responsible for assessing the data and referring to the necessary specialities as clinically indicated. Wedgwood House and the operator will be not responsible for assessing the OPG for the suitability of future treatment or for immediately identifying and referring pathology. I certify that I have obtained the necessary qualifications in order to refer and evaluate the data requested by me and provided.*

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