Radiographic consultation request

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Radiographic consultation services will no longer be offered beginning Sept. 1, 2018.

Requests for consultation on periapical, bitewing, full mouth, occlusal, panoramic or extraoral skull projection radiograph can be submitted directly through this form. Include the patient’s name and date of birth as well as the nature of the concern, any signs/symptoms and results of vitality testing, where applicable.

There is a nominal fee of $50 per case. An invoice will be returned to your office, so also include your office address.

We also provide consultations for cone beam computed tomography (CBCT). Please send the entire scan, not just selected images. Ensure that the file format used is DICOM compatible. The fee is $75 per case.

Checks should be made payable to VCU Dental Care with "OMR Imaging Diagnostic Service" in the MEMO line. If you prefer to make a credit card payment, please phone (804) 628-7640 to process your information.

Salutation

Mr. Mrs. Ms. Dr.

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First name

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Middle name

Last name

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Birth date

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M-D-Y

Gender

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Male Female

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Chief complaint

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Signs or symptoms

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Reason for taking scan

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Results of vitality testing (where applicable)

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Practice or company name

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Staff or provider name

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Practice or company address

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Phone number

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Fax number

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Email address

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Date of the images

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M-D-Y

Additional details

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If multiple images are being sent, save each image as an individual file in a JPEG or TIFF format; combine all images into a zip file no larger than 250 MB.

Refer to the attachment How to ZIP a set of files [PDF] for PC or Mac instructions.

The following image formats cannot be uploaded:
* Paper/printed copies
* Conventional film
* Proprietary file formats
* Photos of images
* Multiple images saved as one file (such as FMX saved as one file instead of as separate images)

Choose file

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Upload file

Send consult to

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Laurie Carter, D.D.S., Ph.D. [Bio]
(Panoramic, extraoral skull and cervical projections and intraoral radiographs only)

Sonali Rathore, B.D.S., M.S. [Bio]

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How would you like our consultations sent to you?

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Secure e-mail Fax First-class mail

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