312-736-7757 VDCchicago@VDC.vet

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Veterinary Diagnostic Centers

Comprehensive Cardiology Form

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Please click on the appropriate location.

Mokena, IL
Chicago, IL
Crown Point, IN

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.

Please indicate who you would like to have discuss with owner: *

Veterinary Diagnostic Centers
Referring Veterinarian

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. (copy) *

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

For comprehensive cardiology cases, thoracic radiographs are highly recommended by the cardiologists. If not provided to us we will ask the owner's consent to perform these.

The cardiologist that will be completing the consultation requests updated bloodwork within 4 weeks of the consult. If this is not provided in the records received do we have your consent to collect and submit? We will of course ask consent of the owner as well. *

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. Please include clinical signs, duration, and any other information that will assist the cardiologist in providing the most accurate report

Are there any concurrent illnesses?

Differential List

List medications and supplements including dosage and frequency that patient is currently on

List any medications that the patient has been on for this problem that have been discontinued

Other comments to share with us that may assist our cardiologist provide the most accurate and useful report for you?

Name

Please indicate who you would like to have discuss with owner: *

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):

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. Please include clinical signs, duration, and any other information that will assist the cardiologist in providing the most accurate report

Are there any concurrent illnesses?

Differential List

List medications and supplements including dosage and frequency that patient is currently on

List any medications that the patient has been on for this problem that have been discontinued

Other comments to share with us that may assist our cardiologist provide the most accurate and useful report for you?

Please indicate who you would like to have discuss with owner: *

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):

For comprehensive cardiology cases, thoracic radiographs are highly recommended by the cardiologists. If not provided to us we will ask the owner's consent to perform these.

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. Please include clinical signs, duration, and any other information that will assist the cardiologist in providing the most accurate report

Are there any concurrent illnesses?

Differential List

List medications and supplements including dosage and frequency that patient is currently on

List any medications that the patient has been on for this problem that have been discontinued

Other comments to share with us that may assist our cardiologist provide the most accurate and useful report for you?

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