South Coast Mobile Imaging Request Form

This form is for referring vet clinics to request an abdominal ultrasound or echocardiogram as a mobile medicine service for our South Coast mobile medicine days. We will only be scanning at one location, Nowra Veterinary Hospital, once a month (not a set day every month) so please submit your request for the next available South Coast imaging day. This date will be confirmed with you once the request is submitted. Our reception team will also call the client confirming the date of booking and take $100 deposit to secure their spot.

This form must be submitted by the referring vet. Please fill out the below information about your client/patient and upload all relevant history, previous imaging, blood work and other diagnostics so that we can process your request as quickly as possible. You will remain the case owner and your patient will be scanned by one of our internists. If you have any further questions, please call or email our team to discuss your case: info@vsos.com.au or (02) 8376 8767. (For reference, the first date will be Friday, 21st of June).

Thank you.

 

REQUEST FORM:

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Referring vet - please fill out the below information about your client/patient and upload all relevant history and blood work so that we can process your request as quickly as possible.
Vet - Email Address(Required)
Client Contact Details(Required)
Brief summary of patient details - name - species, breed, age, weight etc - reason for scanning - relevant patient history

Upload Relevant Recent History

Please upload below all relevant history or conditions that we may need to know about prior to performing mobile diagnostic imaging. Please also upload any relevant lab and pathology results.
Drop files here or
Max. file size: 128 MB.

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