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Emergency
Neurology & MRI
Emergency
Neurology and MRI
Surgery
For Pet Owners
Client Registration
General Information
Online Pharmacy
Pet Parent Portal
Resources
Code of Conduct
Payments
For Veterinarians
RACE Approved Continuing Education Events
Referrals to LAASER
About
Our Mission
Veterinarians
Emergency & Critical Care
Neurology and Neurosurgery
Surgery
Rehabilitation/Integrative Medicine
Doctors
Cardiology
Internal Medicine
Contact
Emergency
Neurology and MRI
Surgery
For Pet Owners
Client Registration
General Information
Online Pharmacy
Pet Parent Portal
Resources
Code of Conduct
Payments
For Veterinarians
RACE Approved Continuing Education Events
Referrals to LAASER
About
Our Mission
Veterinarians
Emergency & Critical Care
Neurology and Neurosurgery
Surgery
Rehabilitation/Integrative Medicine
Doctors
Cardiology
Internal Medicine
Contact
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)
Spayed Female
Female
Neutered Male
Male
Mandatory Client Awareness
Client must be made aware of every topic prior to being referred to VSC for a non-urgent ultrasound.
1. Client has been informed of $688 ultrasound fee.
(Required)
Yes, client has been made aware.
2. This patient will only be imaged by our internal medicine service and the client will not be speaking with the internist unless the ultrasound findings reveal something urgent
(Required)
Yes, client has been made aware.
3. This patient needs to be fasted for at least 12 hours prior to the ultrasound UNLESS the patient is diabetic
(Required)
Yes, client has been made aware.
4. Client is aware that you, the primary veterinarian, will be responsible for reviewing the ultrasound findings and discussing the next steps.
(Required)
Yes, client has been made aware.
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
