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904-417-8589
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Home
About Us
- Testimonials
Our Services
Referring Vets
- Radiology Referrals
  - Imaging Submission Form
  - Ultrasound, Echocardiogram Submission Form
Patient Center

Home
About Us
- Testimonials
Our Services
Referring Vets
- Radiology Referrals
  - Imaging Submission Form
  - Ultrasound, Echocardiogram Submission Form
Patient Center

904-417-8589
Get Directions
Contact Us
Request Appointment

Veterinary Imaging Referrals Ultrasound, Echocardiogram

Veterinary Clinic*
Referral Information
Referring Veterinarian*
Phone Number*
Email*
Patient Information
Patient Name*
Owner Name*
Phone Number*
Email*
Pet Information
Pet's Name
Breed (If known)
Age:
Weight (lbs)
Sex
- Female intact
- Female Spayed
- Male intact
- Male neutered
Select Study
- Abdomen ultrasound
- Echocardiogram
- Echocardiogram with cardiologist interpretation
- Musculoskeletal ultrasound
- Cervical ultrasound
- Thoracic ultrasound
Pet Medical History
Pertinent History (main clinical complaint)
Physical Exam (abnormalities)
For Echocardiogram patients: Heartmurmur
- I
- II
- III
- IV
- V
- VI
For Echocardiogram patients: Heartmurmur loudest
- Left
- Right
- Base
- Apex
- Systolic
- Diastolic
- Continuous
Femoral Pulse
- Normal
- Weak
- Bounding
Laboratory Abnormalities (please provide labwork per email or portal)
Radiographs available (please provide radiographs as DICOM images per email or direct DICOM transfer)
- Yes
- No
Current Medications (medication with dosage)
Any known contraindication for sedation or anesthesia
- Butorphanol (0.2-0.4 mg/kg)
- Dexmedetomidine 2-4 micrograms/kg (not for cardiac patients)
- Midazolam/Diazepam
- Alfaxolone
- Propofol
- Isoflurane
- Others (please specify reason for contraindication)
Additional Comments/Requests

41216

Contact Info

135-1 Cumberland Park Dr
St. Augustine, FL 32095

Phone: 904-417-8589
Email: Info@ecovetsfl.com

Office Hours

Specialty Hospital:
Monday-Friday: 8am-6pm

Emergency Room Temporary Hours:
Monday-Sunday 8am-10pm

24/7 Emergency Care Starting May 5th

Contact Info

135-1 Cumberland Park Dr
St. Augustine, FL 32095

Phone: 904-417-8589

Office Hours

Specialty Hospital:
Monday-Friday: 8am-6pm

Emergency Room Temporary Hours:
Monday-Sunday 8am-10pm

24/7 Emergency Care Starting May 5th

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