Ultrasonography allows us to examine internal organs for size, location, shape, texture and blood supply. It is a non-invasive, low-stress diagnostic tool that can greatly enhance the diagnosis and clinical management of our veterinary patients.

Ultrasonographic examination of the abdomen can aid in the diagnosis of conditions pertaining to:

Vomiting/diarrhea
Abnormal bloodwork
Abnormal radiographs
Unexplained weight-loss
Detection of gastrointestinal foreign body/obstruction
Abdominal fluid detection and ultrasound-guided abdominocentesis
Endocrine disorders
Mass/tumour detection and characterization
Pregnancy detection and viability

Ultrasonographic examination of the heart can aid in:

Identifying location origin of heart murmurs
Assessing cardiac function
Measurement of heart chambers and wall thicknesses for identification and diagnosis of cardiac diseases such as DCM, HCM, MMVD
Determining if pericardial effusion is present

Note: Our ultrasonographic examinations/scans are not interpreted by a radiologist.

If you would prefer to print a PDF copy of this form and fax or email it to us, please click HERE

Please confirm that you have notified the owner of the following details pertaining to their animal's ultrasound: Animals must be fasted for 12 hours prior to the procedure, Animal will have its abdomen shaved for the procedure, Animal may be sedated for the procedure *

I have read and agree.

If you, the referring veterinarian, feel that sedation will be necessary, please note the reason and any sedation concerns/drug preferences for this patient below.

Type of ultrasound requested: *

Complete abdominal
Pregnancy
Urogenital
Echocardiogram

Please complete this form prior to the patient’s scheduled ultrasound appointment.

Referring hospital *

Referring veterinarian: *

Clinic phone number: *

Clinic email address: *

Client name: *

Client's Email *

Phone number *

Address *

Address Line 1

City

State / Province / Region

Patients name: *

Age: *

Species *

Canine
Feline

Breed: *

Sex: *

Male
Neutered Male
Female
Spayed Female

Current medications:

Previous adverse reactions to anesthetic/sedation:

Yes
No

Please describe: *

Relevant medical history:

Results of past procedures/relevant laboratory results:

What questions would like answered from this ultrasound exam?:

The client has been notified that the results will be sent to the referring veterinarian within 24 hours, and unless urgent, will not be discussed with them at the time of the appointment. *

I have read and understand

Ultrasound Referral Form

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