Outpatient Abdominal Ultrasound referral form

Client Information

Address

Patient Information

Is your pet spayed/neutered?
MM slash DD slash YYYY

When abdominal ultrasound imaging is required, veterinarians may refer their patients to Veterinary Specialist of the Rockies for imaging conducted by a board certified radiologist. This is a subcontracted service as a special rate for referring veterinarians and includes the Tech assessment, Doctor exam, patient monitoring, ultrasound. This form is for veterinary use only. Once the ultrasound is completed, the radiologist will call the referring veterinarian with the results.

Expectations:

  1. Results go directly to the referring veterinarian for discussion with their client. Results are not discussed with the client by the Radiologist unless an emergency condition is diagnosed and the referring veterinarian cannot be immediately contacted. Owners will not be present for the ultrasound.
  2. The client pays Veterinary Specialists of the Rockies directly. Pricing as of November 2021 for an Abdominal ultrasound is $550.00. Pricing is subject to change, please call to verify other pricing (recheck ultrasounds) or if the owners have financial concerns.
  3. Patients are encouraged to be fasted after 10pm the night before the ultrasound when possible. All patients may have water. Please inform owners that the patient will be shaved for an ultrasound.
  4. Please include all records, Lab results and/or relevant diagnostic imaging with this form via email or sent with the client.
  5. If a patient requires sedation. There are additional charges for the sedation protocol that is chosen.
  6. All appointments must be set up by the referring veterinary practice. Veterinary Specialists of the Rockies will then contact the client to confirm appointment times.

Please complete the following information:

This field is for validation purposes and should be left unchanged.