Standing CT Referral Form

Owner:*
Horse:*
Referring DVM & preferred contact info:*
Areas of main concern:*
Contrast requested?*
IA/IV/DVM discretion:*
Brief clinical history of patient:*
Imaging attached or sent to officestaff@piedmont.vet?
- Attached below
- Emailed to officestaff@piedmont.vet
Attach files here:
Drop files here or
Whom should we send CT images to for interpretation?
By default, invoicing is done directly to the client. Please reach out to the office at officestaff@piedmont.vet or (540) 364-4950 with questions or concerns.