Refer a CaseReferring Veterinarian(Required)Referring Hospital(Required)Phone(Required)Email(Required) Where will we be seeing this patient?Please selectMy HospitalVeterinary Referral Center for East Tennessee, FarragutSouthwind Animal Hospital, MaryvilleOwner's Name(Required) First Last Owner's Telephone NumberOwner's Email Address Pet's Name(Required)Age(Required)Gender(Required)FemaleFemale, SpayedMaleMale, NeuteredSpecies(Required)DogCatGuinea PigRabbitFerretBirdOtherBreed(Required)Weight (lbs)(Required)Exam Requested(Required)Abdominal UltrasoundAbdominal Ultrasound with Radiologist ConsultEchocardiogram + Screening ECGEchocardiogram + Screening ECG with Cardiologist ConsultEchocardiogram Package 1 with Cardiologist Consult: Echo, 6 Lead ECG, Radiograph Submmission (Acquiring Radiographs not Included)Echocardiogram Package 2 with Cardiologist Consult: Echo, 6 Lead ECG, 3 View Thoracic Radiograph Acquisition and SubmissionThoracic UltrasoundCervical UltrasoundOther (Please provide request below)Reason for Referral(Required)Pertinent History(Required)Please include a basic summary of the chief complaint and physical exam findings. The medical record, images, and test results may be uploaded using the "Add Files" button below.Current Medication / TreatmentIs there anything additional we should know about this patient?Your patient's medical record, images, and lab results may be uploaded here. Files may also be sent via email to contact@etvetus.com Drop files here or Select filesMax. file size: 128 MB.For comfort, and if appropriate for your individual patient, please consider providing pre-medications such as gabapentin or trazodone. Panting or anxious patients may require light sedation to obtain diagnostic studies. Please reach out if you have any questions or if you need assistance. Thank you for entrusting us with your patient's care.Δ
