Request a report | 3D Maxillofacial Diagnostics

3D Maxillofacial Diagnostics

3D Maxillofacial Diagnostics

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Patient Name *

Date of Birth *

Patient Phone *

Patient Address1 *

Patient Address 2

Province *

Postal code *

Referring Dentist Name *

Clinic Email *

Dentist Phone *

Clinic Name *

Chief Complaint *

Date image taken *

Rush Reports (Next Business Day) *

Yes
No

Image Information *

CBCT small F.O.V
CBCT medium F.O.V
CBCT large F.O.V
TMJ CBCT
Comparison between images
TMJ MRI
Panoramic image
Lateral Cephalometric image

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small or Limited Field CBCT CA$100.00
Double small F.O.V CA$150.00

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1

Medium F.O.V CBCT CA$120.00
Large Field of View CBCT CA$150.00

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1

Panoramic image and intraoral images packages CA$50.00
Lateral Cephalometric image CA$30.00

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1

TMJs CBCT CA$100.00
TMJ MRI CA$100.00

(1 / 1)
1

Comparison between images CA$50.00
Urgent Report (Rush Report) CA$30.00

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1

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