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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.
Abdominal
Echocardiogram Only (No ECG)
Comprehensive Echocardiogram (Lead 2 ECG Performed by ASNW)
Thoracic (Non-Cardiac)
Double Cavity (Abdominal Plus An Additional Cavity)
ECG (Either Performed by ASNW or Intrepretation From Your Tracing)
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:
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Male Intact
Male Neutered
Female Intact
Female Spayed
Unknown
Patient Weight:
Clinical Exam Findings:
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Presentation, Physical Exam, etc. Bulleted text is appreciated.
Labratory Findings
Please list most current labwork values - Example: WNL or 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.
Heart Rate and Respiratory Rates
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This is requested by the interpreting cardiologist.
Blood Pressure Measurments
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This is HIGHLY recommended for all cardiac exams, and is routinely requested by our cardiologists.
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, in DICOM format if at all possible. 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/Differential 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 ASNW immediately.
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
Other
Nothing to Email
Notes to the Sonographer (NOT to be put on report anywhere)
If you have anything you want to pass on to the sonographer re: the case, pet, or client that you want to remain confidential, please provide that here. Will NOT be put on the report 🙂
Your Email For Submisson Form Confirmation
*
This is NOT necessarily what email address the report will come to.. the report will be posted to your report portal and an automated email will be sent to the email address you provided on your account
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