Referral form

Patient data


Owner data

Referring Veterinarian

Previous anesthesia or surgery?
Are there any metallic implants in this patient?
Is the patient ambulatory?
Scan Requested

General Information

General anesthesia is required for all CT and MRI examinations. All patients must be fasted for at least 12 hours (if the clinical condition of the patient allows this). A written report will be sent via email or fax within 24h following the scan.

The Referral form must be received prior to the appointment to facilitate safe anesthesia planning.

Please Note: It is very important that you ore one of your associates is available by phone the day of the scan.

Data privacy