Cardiac Consultation Referral Form
For these reports, the default is that our veterinarian will contact the pet owner to discuss the findings. That being said, if you prefer, we can send the report to you to discuss with the client yourself. Please let us know below.
Before you start
- Patient signalment
- History and chief complaint
- Current medications
- Recent bloodwork
- Prior imaging and reports
- Thoracic radiographs — DICOM files are highly preferred over JPEG
If the Comprehensive Cardiology Consultation is selected, thoracic radiograph interpretation is an important part of the echocardiogram report. Thoracic radiographs (the more recent, the better) should be sent with the medical history for submission. DICOM files are highly preferred over JPEG.
We are a Fear Free facility and recommend that an oral sedative be prescribed for the selected ultrasound procedure, although it is not mandatory. You can refer to our suggested oral sedative protocols.
To see what comes back, open our sample echocardiogram report (PDF, identifying details removed).
Please note - Although we do have injectable sedatives available at our facilities, we CANNOT administer these to echocardiogram patients due to effects on the hemodynamics.
Please note - if radiographs are not provided to us, we may perform the radiographs during the patient’s appointment to complete the submission. There will be an additional charge to the client that we will have approved prior to performing. We cannot perform radiographs in our Chicago and Schaumburg locations.
Complete the referral form
The form below is the same referral form you know, filled in on screen.
Fill in the form on screen
Type straight into the form below. Nothing to download or print.
Attach the records
Add bloodwork, prior imaging and reports under Attachments, below the form.
Submit, or hand it off
Submit sends it to our team. “Save and hand off” gives you a link a colleague can open to finish it.
Prefer paper? Download the printable form (PDF).