Southeast Alabama Veterinary Hospital

540 Westgate Parkway
Dothan, AL 36303

(334)671-1990

www.southeastalabamavet.com

Ultrasound Referral Form

Referring Veterinarian (required)

Referral Veterinarian Email (required)

Referral Veterinarian Phone Number (required)

Client Name (required)

Client Phone Number (required)

Which Study (required)
Echo
Abdominal Ultrasound
Patient Name (required)

Species (required)
Canine
Feline
Patient Weight (required)

Patient Age (required)

History and Reason for Referral (required)

Most recent heartworm test and result (required)

Current medications including heartworm and flea prevention as well as any supplements (required)

IF ECHO is requested: Current CARDIAC MEDCATIONS names and dosages and response to treatment (required)

IF ECHO is requested: Have chest radiographs been taken? (required)
yes
no
Please forward history, current lab work, and radiographs to info@southeastalabamavet.com RADIOGRAPHS MUST BE DICOM FILES

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HOURS

Mon-Fri

7:30 am

5:30 pm

Sat

Closed

Sun

Closed

540 Westgate Parkway

Dothan, AL 36303

334-671-1990

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After Hour Emergencies

334-671-1990

GuardianVets after hours triage service will answer your call and forward you to the veterinarian on call.

THIS SERVICE IS FOR CURRENT CLIENTS ONLY.  

Please call your regular veterinarian for after hours emergencies if you are not a current client.

 

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