Outpatient Abdominal Ultrasound referral form When ultrasound imaging is required, veterinarians may refer their patients to Veterinary Specialists of the Rockies for imaging conducted by a board-certified radiologist. This is a subcontracted service at a special rate for referring veterinarians. This form is for veterinary use only. Once the ultrasound is completed, results will be emailed same day to the referring veterinarian. Outpatient Ultrasounds are currently offered Monday through Thursday. To schedule an Outpatient Ultrasound please call 303.660.1027 and submit this form. HOW IT WORKS: All appointments must be set up by the referring veterinary practice. Please call and email back this form along with patient records. Veterinary Specialists of the Rockies will then contact the client to confirm an appointment time. Clients are encouraged to remain at VSR during their appointment. UNSTABLE patients should always come through the Emergency Department. Results go directly to the referring veterinarian for discussion with their client. Results are not discussed with the client unless an emergency condition is diagnosed and the referring veterinarian cannot be immediately contacted. Owners will not be present for the ultrasound. The client pays Veterinary Specialists of the Rockies directly. Current pricing for an outpatient abdominal ultrasound is $550.00. Pricing is subject to change. Please call to verify other pricing (recheck or other types of ultrasounds) or if the owners have financial concerns. Patients should be fasted after 10pm the night before the ultrasound when possible. All patients may have water. Please inform owners the patient will be shaved for an ultrasound. Please include all records and/or relevant diagnostic imaging with this form via email or sent with the client. If a patient requires sedation or an ultrasound guided procedure (such as aspirates), an exam will be performed by one of our veterinarians to establish a valid patient-veterinary relationship. The attending doctor will prescribe and oversee sedation and/or any ultrasound guided procedures as recommended. Additional charges are incurred for the exam and sedation protocol +/- additional testing that is recommended. Costs will be discussed with the client at that time.Contact VeterinarianClinic NameClinic EmailClinic PhoneClinic FaxClient NameClient PhonePatient NameSpeciesBreedAgeSexPresenting Complaint and Reason for UltrasoundHistory and Physical Exam FindingsMedications and DosagesDifferentials or Tentative Diagnosis Δ