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Submit Request Form
Tips For a Smooth Exam
ABDOMINAL IMAGING:
CARDIAC IMAGING:
Request Form
Please CALL or TEXT to set up your appointment (541-357-9423.)
ROUTINE OR STAT?
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IF STAT, PLEASE CALL OR TEXT IMMEDIATELY TO SCHEDULE. BASED ON SONOGRAPHER/SPECIALIST AVAILABILITY. 541-357-9423
ROUTINE
STAT - PLEASE CALL IMMEDIATELY TO SCHEDULE. BASED ON SONOGRAPHER/SPECIALIST AVAILABILITY.
Services Requested
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Please check ALL that apply. If this is a STAT read, please call immediately so that we can make sure we can accommodate this request.
STAT (CALL IMMEDIATELY TO SCHEDULE)
Abdominal
Echocardiogram Only (No ECG or Rad Overview)
Comprehensive Echocardiogram (Lead 2 ECG and Rad Overview)
Thoracic (Non-Cardiac)
Double Cavity (Abdominal Plus An Additional Cavity)
ECG (Lead 2)
Telecytology
Musculoskeletal (Stifles, Shoulder etc.)
Thyroid
Well-ogram (*Special Conditions Apply, Please Call)
Other
Reproductive/Pregnancy Check
Hospital Name
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Overseeing Veterinarian
Patient's First Name
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Patient's Last Name
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Species:
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Breed:
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Patient DOB or AGE:
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Patient Gender:
Male Intact
Male Neutered
Female Intact
Female Spayed
Unknown
Patient Weight:
Clinical Exam Findings:
Presentation, Physical Exam, etc. Bulleted text is appreciated.
ABNORMAL Labwork Values
Please list any abnormal lab work values. Example: ALT 400, BUN 47. You can alternatively email them to: info@animalsoundsnw.com The specialists have recently requested full lab work along with the ultrasound to provide the most detailed case read.
For ECHO Only: Blood Pressure
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This is requested by the interpreting cardiologist.
HR/RR/BP:
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This is requested by the interpreting cardiologist.
Is there a Heart Murmur? If so, please grade.
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This is requested by the interpreting cardiologist.
Current Medications
Any medications patient is currently on, or has been administered in the last 24 hours.
Radiographic Findings
You may send up to 3 CURRENT radiographs that are of the same cavity that is being examined. These will supplement the ultrasound, however the main ddx will be made off the ultrasound itself. Please contact me if you have further questions. Email radiographs to: info@animalsoundsnw.com
Primary Question to Be Answered in This Exam
Have you been able to login to the report portal from Sonopath to view and download your reports?
Sonopath is now posting your ultrasound reports via their reports website at: reports.sonopath.com. Please use your login into that was sent to you to retrieve the report. If you cannot login, please contact Sonopath at 800-838-4268.
Yes
No
Fine Needle Aspirates
At the time of the ultrasound, fine needle aspirates might be indicated, and if approved on-site by Sonopath DVM, can be performed following the ultrasound. However, client permission must be obtained prior to sampling.
Client approved Sedation Only
Client approved Sedation and FNA Consent
Client did not approve sedation nor FNA
Check boxes below if you are emailing bloodwork or radiographs
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If Yes, Please email them info@animalsoundsnw.com Note: Radiographs in DICOM (.dcm) format if at all possible.
Emailing Bloodwork
Emailing Supporting Radiographs
Nothing to Email
Email for Submission Confirmation & Contact
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