REFERRAL FORM

    Practice Details

    Patient Details

    3D CBCT area of interest


    Both Arches
    Mandible
    Maxilla
    Small Field of View - 5x5cm or 8x5cm
    OPG

    Justification for scan (IRMER 2000):


    Implant treatment planning (assessment of position of anatomical structures, bone quality and quantity)
    Orthodontic assessment and planning
    Endodontic assessment
    Sinus graft
    Wisdom teeth assessment
    LL8
    LR8

    To be completed by the referring practitioner: This will act as the practitioner’s electronic signature: I hereby authorise Oak Hill Dental to carry out a 3D CBCT on my behalf. When scanning guides are used, these guides will be prepared in advance by the referring dentist and given to the patient to bring to the scan appointment. The results of the scan will be returned on a USB with basic viewer software. Although an evaluation of the scan will be carried out I am responsible for assessing the data and referring to the necessary specialties as clinically indicated. Oak Hill Dental and the Operator will not be responsible for assessing the scan for the suitability of treatment or for ultimately identifying and referring pathology; by referring the patient I am accepting this responsibility. The HPA CRCE-010 guidelines suggest that attendance of a CBCT Training Certificate Course is deemed a regulatory requirement for all users of CBCT systems, including those who are simply referring patients for acquisition of a CBCT image. I accept that it is my responsibility to obtain the necessary qualification in order to refer and evaluate the data requested by me and provided by Oak Hill Dental. Alternatively, I will arrange for a Consultant Radiologist, or a suitable individual, to rule out coincidental pathology.


    I will make my own arrangement for reporting of my Cone Beam CT scans acquired at YOUR Centre. This will be done by someone adequately trained as per HPA-CRCE-010 Guidance on the safe use of Dental Cone Beam CT
    I will report my Cone Beam CT scans acquired at YOUR Centre. I confirm that I am adequately trained to interpret cone beam CT scans as per HPA-CRCE-010 Guidance on the safe use of Dental Cone Beam CT. I will ensure that my training remains up to date.

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    Read Our Reviews!

    Amir K
    Amir K
    2023-07-18
    The staff at this practice are unparalleled! The most friendly and helpful staff I have ever had the experience of dealing with at a dental practice. Rahana and Usman have not only saved the day countless times for me personally, but are always such a joy to interact with. Thank you for making the dental experience so much better!
    Patricia Paraschiv
    Patricia Paraschiv
    2023-07-15
    I am thrilled to express my immense gratitude for the exceptional care provided by Dr. orthodontist Suhaym Mubeen. The level of dedication, compassion, and professionalism exhibited by him surpasses all expectations. Dr. Suhaym's approach is marked by thoroughness, thoughtfulness, and meticulousness. His genuine concern for his patients is unparalleled. As a perfectionist, I greatly appreciated his unwavering attention to detail throughout my two-year treatment. His passion for his chosen profession is evident, and his involvement and care were nothing short of outstanding. One of the aspects that truly sets Dr. Suhaym apart is his willingness to take the time to explain each step of the treatment process, ensuring that I understood the purpose and benefits of every decision made. His explanations helped me make well-informed choices for my long-term oral health, instilling confidence and trust in his expertise. Every visit to Dr. Suhaym's office was a joyful experience, thanks not only to the exceptional services he provides but also to his exceptional team of colleagues, including the hygienists and general dentistry practitioners. The reception staff deserves a special mention for their friendliness, professionalism, and ability to create a welcoming and enjoyable atmosphere. I consider myself incredibly fortunate to be a patient of this outstanding practice. In summary, there are simply not enough words of thanks to adequately convey my gratitude to Dr. Suhaym Mubeen. His level of care, commitment, and professionalism is truly second to none. I wholeheartedly recommend him to anyone in search of an orthodontist who will go above and beyond to provide an exceptional experience and deliver outstanding results.
    Oliver L
    Oliver L
    2023-07-04
    Went to Oak Hill dental pratice to have my wisdom tooth removed, this was my first tooth extraction however Dr Ali was very empathetic, alivated any nerves I had and was very quick with the procedure. Highly recommended!
    Will Hooper
    Will Hooper
    2023-06-30
    Just finished my final Invisalign session with orthodontist Suhaym Mubeen and felt compelled to leave a review after the incredible service I've received from him and his team over the past year. His diligence and attention to detail has been amazing and I am beyond happy with the results. He works and communicates with great clarity and care. And whilst he conducts himself very professionally, he does so with a warm, friendly energy that has honestly made the whole experience really nice. What a legend.
    alan croucher
    alan croucher
    2023-06-21
    I received first class treatment from Dr. Ali. Dental treatment is never a pleasure but the process of installing an implant was virtually painless and the procedure was competently conducted.
    sumayya choudry
    sumayya choudry
    2023-06-12
    Fantastic dentist practice. Ive had wisdom teeth problems for over 4 years and recently had a coronectomy on both sides at a NHS hospital near me. One side would not heal and I was in constant pain, I was told for 6 months that it has healed and the pain is jaw related and I should just continue with pain killers. I sent the photos and x-rays to Dr Ali and he was more than happy to walk me through what needed to be done and spent time listening to me and was genuinely interested in helping (and not in it for a profit as I've had in other private practices). I am now pain free after months of constant pain, and I am so grateful to Dr Ali and his team for their help.
    Androulla Kilikita
    Androulla Kilikita
    2023-06-07
    5 star implant done at oakhill dental practice, very pleased, but a bit more expensive as I needed a bone graft
    Jose Martin
    Jose Martin
    2023-05-11
    Always easy peasy
    tony sobers
    tony sobers
    2023-04-29
    It took seven weeks to go from smashed front teeth to veneers and a perfect smile thanks to Dr Ali and the team at Oak Hill Dental Practice. Eight weeks before my wedding I fell and suffered serious damage to my face and teeth. Over the following weeks and a series of appointments Dr Ali set about repairing the damage, each session gave me more hope that I’d have a toothy grin for my wedding photos. Dr Ali and the team were totally supportive and reassuring during the treatment. And the result of the dental work was amazing, I had to tell people I’d had an injury, they wouldn’t have known otherwise. I’m loathed to change dentists and despite moving away from the area I stayed with Oak Hill as I know they are great, that confidence paid off. I can thoroughly recommend the entire team at Oak Hill Dental Practice, you’ll be in good hands
    Mike Bliss
    Mike Bliss
    2023-04-25
    After recently finishing a series of dental treatments, leading to the fitting of a new implant and two replacement crowns for my front teeth, I have nothing but the highest praise for the team at the Oak Hill Dental & Implant Centre. After the initial consultation, assessment, and CT scan - which revealed insufficient bone to take an implant - Dr Moshin Ali drafted an impressive four-phase plan which was described to me clearly and professionally and in a manner that put me completely at ease. The most daunting procedures - including both bone and gum grafting surgeries - went extremely well, and the aftercare was excellent with follow up calls from the doctor's reassuringly calm and efficient assistant, Mihaela. As we came towards the end of the treatments Moshin took a great deal of time and care to achieve a very natural look and I am delighted with the results. Kudos also to Steve and the other receptionists who are always most welcoming, patient and helpful when you arrive or call. I have no hesitation in recommending this practise. Thank you so much!
    Read All Reviews

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