312-736-7757 VDCchicago@VDC.vet

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Veterinary Diagnostic Centers

Basic Abdominal Ultrasound Form

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Please click on the appropriate location.

Mokena, IL
Chicago, IL
Crown Point, IN

For basic abdomen and basic echocardiograms, the default is that the referring veterinarian discusses the report with the owner. That being said, Veterinary Diagnostic Centers can discuss the results if requested here. Please note here who you'd like to report the results: *

Veterinary Diagnostic Centers
Referring Veterinarian

Comprehensive Internal Medicine Consultations and Comprehensive Cardiology Consultation reports will automatically be discussed with the client by our veterinarian, Dr. Bloomberg, and then referred back to you for the recommended treatments and follow-up. If you'd prefer a full consultation please fill out that form which can be found here.

We are a Fear Free facility. We suggest that an oral sedative be prescribed but this is not mandatory. If you and the family believe this is not necessary we can do without. For suggested protocol please refer to our Referring Vets dropdown. Please indicate whether an oral sedative will be prescribed. *

Our Reports are received within 12 business hours typically. Do you request an expedited (STAT) report to be received in 2 business hours? This would need to be approved by the pet owner as there is a $95 fee for expedited report.

We have only needed to administer an injectable sedative to less than 1.0% of our patients. Please indicate if you believe, due to aggression or other behavioral concerns, that this will need to be done with this patient. *

Are there any matters concerning the client or the pet that we should be made aware of (will be kept confidential)?

Are there any blood or urine tests you'd like us to collect as our patient will be fasted and we have the ultrasound for urine collection?

Please upload medical records, labs, images, and previous referral reports.

Click or drag files to this area to upload. You can upload up to 5 files.

Client Name

First

Last

Client Phone

Patient Name

Patient Weight

Patient Age

Referring Veterinarian Hospital

Referring Veterinarian

Email or Fax number where you’d like results sent:

Reason for the Exam

Are there any concurrent illnesses?

Differential List

Are there any specific organs you’d like us to focus on?

Phone

Veterinary Diagnostic Centers
Referring Veterinarian

Are there any matters concerning the client or the pet that we should be made aware of (will be kept confidential)?

If we believe an FNA of an intra-abdominal structure would be safe and worthwhile do we have your consent to perform and submit? We will seek the consent of the pet owner as well, discussing risks and costs with them.

Other than an FNA are there any blood or urine tests you'd like us to collect as our patient will be fasted and we have the ultrasound for urine collection?

Please upload medical records, labs, images, and previous referral reports.

Click or drag files to this area to upload. You can upload up to 5 files.

Client Name

First

Last

Client Phone

Patient Name

Patient Weight

Patient Age

Referring Veterinarian Hospital

Referring Veterinarian

Email or Fax number where you’d like results sent:

Reason for the Exam

Are there any concurrent illnesses?

Differential List

Are there any specific organs you’d like us to focus on?

Phone

Veterinary Diagnostic Centers
Referring Veterinarian

Are there any matters concerning the client or the pet that we should be made aware of (will be kept confidential)?

Other than an FNA are there any blood or urine tests you'd like us to collect as our patient will be fasted and we have the ultrasound for urine collection?

Please upload medical records, labs, images, and previous referral reports.

Click or drag files to this area to upload. You can upload up to 5 files.

Client Name

First

Last

Client Phone

Patient Name

Patient Weight

Patient Age

Referring Veterinarian Hospital

Referring Veterinarian

Email or Fax number where you’d like results sent:

Reason for the Exam

Are there any concurrent illnesses?

Differential List

Are there any specific organs you’d like us to focus on?

Name

Veterinary Diagnostic Centers in Chicago, IL

Veterinary Diagnostic Centers is here when your veterinarian needs additional diagnostic expertise for your pet’s care. Your doctor has the flexibility to recommend just an ultrasound report or, for more involved cases, a full remote specialist consultation that we will coordinate.

Referral Forms