CT Referral Form

Save time getting your pet’s necessary diagnostics by completing your required CT referral form online.

For patients undergoing anesthesia (all CT Scan procedures):

  • Please provide a CBC & Chem screen no older than 30 days.
  • All patients must fast for 6 to 8 hours prior to a CT scan.
  • We will administer an antacid and anti-regurgitation medication (i.e., Pantoprazole, Famotidine, Maropitant, etc.) parenterally at the time of catheter placement to decrease — not eliminate — the risk of anesthesia related esophagitis.

For patients undergoing a procedure without anesthesia (i.e., swallow study or tracheal fluoroscopy):

  • Please bring a regular portion of your pet’s food.
  • For swallow studies, patients should be fasted 18-24 hours unless medically contraindicated (against veterinarians advice)
  • No additional preparation is needed.

Veterinarian Info

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Patient Info

Type Of Imaging Requested

You may check more than one region if necessary. Note that each region incurs additional fee.

Reason For Imaging

Patient History

This helps us when designing anesthetic procedures and interpreting the images.

We cannot perform any imaging without pertinent medical records (most recent laboratory tests and veterinarians medical notes
We cannot perform any imaging without pertinent medical records (most recent laboratory tests and veterinarians medical notes

Current Medications