Radiology Referral Form *Required Referring Veterinarian Information How would you prefer to be contacted about this case?PhoneFaxEmail Client Information Patient Information SPECIES: Avian/ExoticCatDogOther SEX: FFSMMNUnknown Reason for Referral(There is no need to submit history, labs, or radiographs. A brief summary below is sufficient) Test to be Performed UltrasoundAbdomenNon-cardiac ThoraxNeckOther Radiography/Contrast Procedure CT Scan Please inform the owner of the following Food should be withheld for 12-15 hours prior to the procedure for optimal image quality and in the case that sedation/anesthesia is required. If this is not possible for medical reasons, please contact us. Withholding water is not necessary.For ultrasonographic procedures, the area of interest will be shaved to optimize image quality and maximize the diagnostic potential of the test.For other tests, please call us for specific preparatory instructions.Owners will not be given the results of the imaging procedures performed except under certian, critical circumstances. The owners will be asked to contact your office for imaging results, and to make plans for further actions. This is to keep you in control of your case and to simplify communications.If you wish to have another doctor at our facility go over the imaging results with the owner and make further recommendations, please speak to the imaging department to set up the appropriate consultation.Biopsies, needle aspirates and other interventional procedures are not scheduled as outpatient procedures and cannot be performed as an add-on to an outpatient exam except in critical cases where the case is transferred to a staff doctor for case management. Routine, non-emergent procedures can be scheduled through the imaging department as day-admits. Please call us for more information.