Telecardio Vet

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Services
About Us
FAQ
Contact Us

Service Contract Complete the form to request a service contract

Select Service

Service Type^*

Referring Veterinary Surgeon's Information

Vet's Name^*

Vet Clinic and Branch^*

Clinic Telephone Number^*

Email^*

Date^*

Patient/Pet Information

Animal's Name^*

Species^*

Breed^*

Weight in Kgs^*

Sex/Neutered^*

Age^*

Nature of Problem/Reason for Cardiology Consultation

Please describe the pet's condition and provide a brief summary of the relevant history^* NB: This history summary needs to be provided in addition to attaching the patient records.

What date is the patient history relevant from, or when did the patient first present with this condition?^*

Is this case an Emergency, Urgent or Routine request?^*

Please list current medications^*

Any other relevant information

Patient Records and Relevant Diagnostic Test Results

X-Rays / Imaging^*

Yes

Lab Results^*

Yes

Patient Records^*

Yes

Previous Relevant Referral Reports

Getting the Most out of Your VVS Consult

Please tell us what question(s) you would like to answer about this case^*

Please also tell us what you are hoping to achieve from this consult^*

I would like to save my surgery information for next time I fill out this form.

I accept the policy privacy^*

We are a team of veterinary cardiologists who are dedicated to providing the best possible care for your pet.

Contact Us

Ready to provide expert cardiac care for your patients? Get in touch with us today.

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