OUTPATIENT CT REFERRAL FORM

Outpatient CT Referral Form

If requesting an outpatient CT study, the requesting clinician will be solely responsible for communicating the results and making treatment recommendations based on the findings. If a consultation with a specialist is desired, then an appointment must be scheduled with a specialist instead of an outpatient CT.

Please complete the form below and upload or email the patients most recent 2 years of medical records, lab work and radiographs when applicable to info@lancastervs.com. After review of the submitted information, a CT technician will be in contact for scheduling. Please feel free to call us with any further questions.

CT Referral Form

  • Pet Information

  • Please indicate patient weight in kilograms.
  • Primary Veterinarian

  • Patient Case History

  • Please upload or email the patients most recent 2 years of medical records, lab work and radiographs when applicable to info@LancasterVS.com

  • Choose Files or drag here
  • This field is for validation purposes and should be left unchanged.