Please note that the Radiograph Review Fee is $50 with our Radiologist, Dr. Hanson, $55 with our Cardiologist, Dr. Koplitz. Referral Information Referring DVM Name: * Referring Veterinary Hospital: * Referral Type ---Choose One---Patient ReferralPatient TransferImaging ReviewOutpatient Ultrasound Referral Service * ---Choose One---AnesthesiaCardiologyDentistryEmergencyInternal MedicineNeurologyOncologyOphthalmologyRadiologySurgery Client / Patient Information Client Name: * Client Address: * Client Telephone: * Client E-mail: * Patient Name: * Patient Species / Breed: * Patient Date of Birth: * Patient Sex: * ---Choose One---Male, NeuteredFemale, SpayedMaleFemaleUnknown Patient Weight: * Chief Complaint/Tentative Diagnosis: * History/Exam Findings Treatments Records and Images You can upload records and images using the upload links below. We accept nearly all file types (jpeg, pdf, doc) including DICOM images (dcm) and zip files. If you prefer, you can also send images directly to us via DICOM-send from your computer, or upload via the image portal. Medical Records Images Captcha * Click the image to see another captcha.