205-235-8759
referral@vovcbham.com
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Orthopedic Radiograph Consultation
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Referring DVM
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Orthopedic Radiograph Consultation
This service comes at no charge.
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Please complete this form:
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To maintain the integrity and quality of medical images, we only accept DICOM imaging format for radiograph consultation.
Date
*
Referring Veterinarian Name
*
First
Last
Practice Name
*
Requesting Veterinarian Email Address
*
Referring Veterinarian Telephone Number
*
Patient Name
*
Sex
*
Male
Male Neutered
Female
Female Spayed
Patient Species
*
Dog
Cat
Patient Weight
*
Patient Age
*
Patient History
*
Link to the radiographs (IDEXX, Antech, Heska, etc.)
Does the link above require a password to view the images?
*
Yes
No
Password:
*
DICOM Images
Drag & Drop Files,
Choose Files to Upload
You can upload up to 10 files.
Phone
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