Request CBCT Appointment

Request CBCT Appointment Form

01Patient Information

Please enter a valid telephone number.
Please enter a valid date of birth.
Referring Doctor

02CBCT Information

Please enter a valid type of ct scan requested.
Please enter a valid area of interest.

03Additional Remarks

* Appointment time is reserved for you. Please be aware that 48 hour notice is required to reschedule your appointment to avoid a cancellation fee. All appointments must be confirmed.
Suite 237 - 1338 Fourth Ave, St. Catharines

Monday - Friday: 8am - 5pm

Payment Options

Your consultation appointment will provide you with a predetermination outlining the costs of your upcoming treatment. Payment will be due at the time service is rendered. We accept Visa, Mastercard, Debit, American Express or cash payments. If you have insurance coverage, we can assist you in submitting your claim electronically or provide you with the forms necessary for you to submit independently.

Book a consultation with us today.

Request Appointment