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Emergency

Abdominal Ultrasound Referral Form

Coming to Eagleson Veterinary Clinic from another clinic? Please have your clinic fill out our online Abdominal Ultrasound Form to help us understand your pet’s medical history and develop a plan.

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Ultrasound Referral Form

FOR REFERRING CLINICS USE ONLY:

This service provides an abdominal ultrasound and a report to the referring veterinarian. The referring veterinarian remains responsible for discussing the findings with the client, recommending treatment and arranging follow-up.

If you would like EVC to assume responsibility for the case, please refer the patient for an Consultation first. The EVC veterinarian will assess the patient and arrange imaging internally as indicated.

Referring Clinic and Veterinarian

Client and Patient Information

Clinical Referral

Include the clinical questions you would like the ultrasound to address.
Include duration of signs, progression, previous treatment and response.
Drag & Drop Files, Choose Files to Upload You can upload up to 5 files.
Please attach complete laboratory results, previous imaging reports and relevant medical records. Accepted file types: pdf, jpg, word, png, dicom, Max. file size: 128 MB.
Include doses, frequency and any prescribed pre-visit medication.
Include fear, anxiety, stress, bite history, handling triggers and successful handling strategies. Patients with FAS equal or above 2 must be dispensed PVPs for the night before and the morning of the procedure.
Please discuss possible sampling and associated laboratory testing with the owner before the ultrasound appointment.
Include fear, anxiety, stress, bite history, handling triggers and successful handling strategies.

Sampling Requests and Advance Consent

Please discuss possible sampling and associated laboratory testing with the owner before the ultrasound appointment.
Include any lesions or organs not to sample and any limits on testing.
Non-urgent procedures or tests outside the approved scope will be deferred if the necessary authorization cannot be obtained.