Is this an urgent referral? *

Yes
No

If you suspect you have a life threatening cardiac case, we recommend to redirect this patient to our emergency department.

Reason for referral *

Referring Veterinary Practice *

If Other *

Referring Veterinarians Name *

Client Name *

First

Last

Client Email *

Client Primary Phone Number *

Client's Home Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Patient Name *

Species *

Feline
Canine

Breed *

Sex *

Male
Neutered Male
Female
Spayed Female

Birthdate *

Is the patient fractious? *

Yes
No

Oral Sedatives

All cats must be prescribed gabapentin and all dogs must be prescribed Trazodone +/- Gabapentin prior to their appointment.

To avoid stress and to increase our ability to obtain the best quality images, all patients are required to come to their appointment with oral sedatives on board. These oral sedatives will not affect our testing. If the patient is experiencing severe bradycardia (HR <100 bpm for cats or <50 bpm for dogs), please contact us to confirm appropriate dosing. As the referring veterinarian, it is your responsibility to determine the appropriate dose of sedation for your patient. Please follow the recommended dosing guidelines below:

Cats: 100 mg Gabapentin, the night before and 2 hours before the appointment. A higher dosage can be considered for patients known to be extra fractious or anxious.

Dogs: Trazodone 3-5 mg/kg and/or Gabapentin 10 mg/kg, the night before and 2 hours before the appointment.

I acknowledge and understand the reasoning for arranging oral sedatives. I have informed the client and dispensed the appropriate medication(s). If this is an emergency setting, the client has been advised to follow up with their primary veterinarian. *

Yes, I understand and have or will arrange the oral sedatives.

Please list any relevant medications, along with any additional comments:

Please upload any medical records and relevant diagnostics: *

Drag & Drop Files, Choose Files to Upload You can upload up to 5 files.

Please ensure all client information is accurate, as this will allow our team to contact the client without delay.

Referring Veterinarians

Emergency Services

Cardiology Referral Form

Oral Sedatives

Veterinary Services

Contact Details