Veterinarian's Referrals - Los Angeles Animal Specialty Emergency & Rehabilitation

Veterinarian’s Referrals

All non-urgent patients being referred for just ultrasounds must have this completed form submitted by the referring veterinarian before they are able to be seen by our Imaging Department.

This form should be completed by a veterinarian.

Referring Veterinarian's Information

First Name(Required)

Last Name(Required)

Clinic(Required)

Email(Required)

Client's Information

First Name(Required)

Last Name(Required)

Phone(Required)

Client's Email(Required)

The client will automatically receive an email that we have received your ultrasound referral along with detailed instructions.

Patient's Information

Patient's Name(Required)

What is your pet's species?(Required)

Canine

Feline

Weight (kg)(Required)

Breed(Required)

Age(Required)

Sex(Required)

Mandatory Client Awareness

Client must be made aware of every topic prior to being referred to VSC for a non-urgent ultrasound.

Any size files can also be uploaded below.
Records can also be sent separately to help@vetspecialty.com.

Reason for Non-urgent Ultrasound(Required)

Primary Problem(s)(Required)

Pertinent Medical History(Required)

Diagnostic Tests Performed/Results(Required)

Type NONE if applicable.

Current Medication(Required)

Type NONE if applicable.

Previous surgical and/or other procedure(s) and date(s)(Required)

The Ultrasound Report will be emailed to you after the scan at the email address provided above

Submit Ultrasound Referral information here

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