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Telephone:

01883 741440

Vets Telephone:

01883 741449

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Outpatient Imaging Service Form

Please complete the following details:
(NB: This form should ONLY be used by Veterinary Professionals, not by pet owners)

If you are sending images to accompany a case that is being referred, please submit these via our online case referral page

If you wish to discuss a case with one of our Specialists but do not require a written report, please phone us on 01883 741449.

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Veterinary Surgeon's Details (About You)

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Owner's Details

NB: Please ensure that telephone numbers are current and accurate and include an STD code

In the event of any queries, and for clients preferring to book their appointment with us directly, please indicate the owner's preferred contact method:

Patient's Details

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Details of Referral

Attach blood results from last 2 weeks if sedation or anaesthesia required

For CT and MRI procedures I certify to the best of my knowledge this patient is safe to undergo routine sedation or anaesthesia where required

 

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Previous Imaging

(please attach images including report if available)

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Note: We accept files in the following formats: .pdf, .doc, .docx, .xls, .xlsx, .rtf, .txt, .jpg, .bmp, .gif, .tiff, .png, .dcm, .eml, .zip

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