External Imaging Referral - ECHO/ US
Referring Vet Details
Referring Vet Name
Email (imaging study will be sent here):
Date of Birth
Has the patient had/ will have had a pre GA blood test within 14 days of the imaging study?
Is the patient pregnant?
Does the patient have any preexisting conditions or allergy?
Is the patient on any medication?
Is the patient currently hospitalised?
If the findings indicate a FNA or minor procedure, do you want to proceed at the Veterinarian's best judgement?
If you answered yes to any of the above, please list the details/ medications.
Please list a brief clinical summary/ working diagnosis.
What are the clinical signs/ symptoms?
Imaging Study Details
Please select the desired ultrasound study.
Abdomen and Echcardiography
Please select if any of the additional services are required.
Ambulance transfer (Patient only - at cost to the owner)
Pre GA blood work (If has not been completed with 2 weeks of study - at cost to the owner)
Keep IV catheter in place (Only applicable if patient is returning to ref vet)
Declaration & Documentation
Terms and Conditions
Please upload blood results, previous imaging, and any other relevant documentation.
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