To get started, simply print the form in the link below.  Fill out the section "Doctor's Office Only" providing us with the name of the patient as well as the name, address and phone number (or use your office stamp in this section) of your practice so we know who/where we are to deliver results.  Mark if the payment responsibility is for the doctors office or the patient.  Then mark the Format Options.  You can mark any one or more of the format options.  If you would like an email of the results, Mark the box "Images Emailed" and also provide us with your email address.  Then fill out the section "NewTom Cone Beam CT Scan" so we know exactly what areas you want us to specifically review for you.  Give this completed form to your patient just like you would have done in the past but the difference is instead of the patient going to a lab, the patient will call us (phone number on top of form 949-282-0083) and we will set up a day and time that is convenient for the patient.  We will drive to their home or work in our service area.  IT'S THAT EASY!

3D Advantage Referral

If you would like to use our service, please fill out the form in the link below.  This form will ensure that we deliver results to the correct address.  Once we receive the "New Office Enrollment" form, we will send you our "Price List" via email.

New Office Enrollment

If you would like your office to be billed for services instead of having the patient pay at the time of the scan, you MUST mark the box Payment Responsibility: Doctor on the 3D Advantage Referral.  You MUST also fill out the form in the link below.  We will charge your credit card for services provided at your request only. Fax this completed form to our secure fax line at 949-382-1442. 

Credit Card Authorization

If you or your patient has previously had a scan with our company and would like to request a copy or additional work up on a different area, please fill out the form in the link below.  We will provide you with an email, disk or printed images. (There may be an additional charge for these services.  If there are additional charges, we will email you with a quote before starting the work). 

Request for Copy of Previous Dental Scan

Let 3D Advantage, LLC be your service provider using our Mercedes Benz fleet of sprinter vans.