Outpatient Echocardiogram Referral Form

Outpatient Echocardiogram Referral Form

Referral Information

Information

Client (Owner) Name *

Patient Name *

Species *

Sex *

Referring Veterinarian *

Contact number to be immediately reached at conclusion of echocardiogram *

Pertinent History

Clinical History (primary reason for imaging, physical exam findings, recent lab work [within 30 days] pertinent medical history, etc.) *

Spam Blocker

Important Information About Echocardiogram Only Appointments

For echocardiogram procedures, the area of interest may be shaved to optimize image quality and maximize the diagnostic potential of the test.
Owners will not be given the results of the imaging procedures performed except under certain, 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, a consultation with the Cardiology department or the Emergency department must be scheduled in conjunction with the echocardiogram-only appointment. Please contact us to schedule the appropriate consultation.

Other interventional procedures are not scheduled as outpatient procedures and cannot be performed as an add-on to an echocardiogram-only appointment. All routine, non-emergent procedures can be scheduled through the Cardiology department as consultations. Please contact us for more information.