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Ultrasound-only Referrals

If your patient needs just an ultrasound and is non-urgent and stable, please submit the following ultrasound-only referral form to our team. Once we have received this completed form with applicable records from the referring veterinarian, the patient’s family will automatically receive a text and email with detailed information on next steps including how to schedule an outpatient ultrasound appointment up to 1 week in advance.

Outpatient Ultrasound Appointments*
Monday - Saturday

*Excludes holidays and is subject to availability.

Referring Veterinarian's Information
First Name*
Last Name*
Clinic*
Email*
Would you like to receive VSC's Referring Veterinarian Newsletter?
- Yes, please.
- No, thank you.
Personal Email*
Client's Information
First Name*
Last Name*
Client's Mobile Phone*
The client will automatically receive a one-time SMS text message that we have received your ultrasound referral and asks them to check the provided email for detailed instructions. The client can reply STOP at any time to opt out.
Client's Email*
The client will automatically receive an email that we have received your ultrasound referral along with detailed instructions.
Enter Email Confirm Email
Patient's Information
Patient's Name*
Species*
- Canine
- Feline
Weight (kg)
Breed*
Age*
Sex*
Mandatory Client Awareness
Client must be made aware of every topic prior to being referred to VSC for a non-urgent ultrasound.
1. Client has been informed of $755 ultrasound fee (one body cavity).*
If additional diagnostics such as fine-needle aspiration are necessary and able to be performed, the Imaging Department will provide an appropriate estimate to the client and will only proceed with their consent.
Yes, client has been made aware.
2. This patient will only be seen by our imaging department and the client will not be speaking with a VSC doctor unless the ultrasound findings reveal something urgent.*
Yes, client has been made aware.
3. Non-urgent ultrasounds are performed by appointment Mondays through Saturdays, but clients may experience a wait of up to two hours as critical patients may be prioritized.*
Yes, client has been made aware.
4. This patient needs to have been fasted for 12 hours prior to the non-urgent ultrasound.*
Yes, client has been made aware.
5. Client is aware that you, their primary veterinarian, will be responsible for reviewing the ultrasound findings and discussing the next steps.*
Yes, client has been made aware.
6. Patient may need to be sedated for safety and/or diagnostic accuracy reasons, but there will not be any additional fees for sedation.*
Yes, client has been made aware.
7. Client is aware that this referral is only good for the next 30 days.*
Yes, client has been made aware.
Medical Information
Any size files can also be uploaded below.

Records can also be sent separately to help@vetspecialty.com.
Body cavity to ultrasound*
Please note that selecting more than one cavity to ultrasound will incur additional fees.
- Abdomen
- Chest
- Neck
Reason for Non-urgent Ultrasound*
Primary Problem(s)*
Pertinent Medical History*
Diagnostic Tests Performed/Results*
Type NONE if applicable.
Current Medication*
Type NONE if applicable.
Previous surgical and/or other procedure(s) and date(s)
Are there any concerns or contraindications for sedation or anesthesia for this patient?*
- No
- Yes
Please list your concerns or contraindications for sedation or anesthesia of this patient*

Upload Any Size Files (records, labs, radiographs, ultrasounds, MRIs, CTs, etc.)

Please upload a one-year history, current blood work, imaging, and any other relevant information.

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Phone
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