We're Accepting New Patients

Echocardiography Referral Form

Please complete this form at least 24 hours prior to the appointment and ensure you have notified the client of the following:

  • Patient should not be fed within 2 hours of the scheduled appointment but can have normal access to water
  • Patient will be shaved and may need to be sedated to obtain diagnostic images
  • Dogs should be given trazodone 2 hours prior to appointment unless their regular DVM deems it unsafe
  • Cats must be given gabapentin 2 hours prior to appointment unless their regular DVM deems it unsafe 
  • Client has been given an estimate of cost (please call for more information if needed)
  • Client will receive results via their regular DVM, typically within 24-48 hours of the appointment

Which practice would you like to register with?

REFERRING HOSPITAL INFORMATION

CLIENT INFORMATION

PATIENT INFORMATION

Patient Should Be Seen (if possible)
In addition to echocardiogram, please also perform:
Indications/Clinical Signs
Do you need comments on anesthesia for a procedure planned in the short-term future?

**Patient history must be provided prior to the appointment date**

 

Patient History may include:
1. Medical Records
2. X-rays
3. Lab Results
4. Other Documents

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