Referring Practice details





PATIENT DETAILS





Area:

HeadC1-T2T1-L1L1-SacrumOther




Please bill:

OwnerThe Vets

Attached history:





All reports are delivered to the email address above within 48hours (working) of the scan if you wish an urgent report then it can be done within 4 hours for an extra £90, please ask if wish need any specific details regarding your referral.

PLEASE ENSURE YOUR CLIENT HAS SIGNED YOUR GENERAL ANASTHETIC CONSENT FORM.

NOTE: By submitting this form you confirm that you are a qualified veterinary surgeon who has obtained consent from the patient’s owner to act on behalf of the animal described above: that the owner has given permission for the administration of an anaesthetic/sedative to the above animal at the imaging location together with any other procedures that may prove necessary: and that the owner understands that in the unlikely event of an emergency or where additional pain relief or sedation may be required, the imaging branch will act in the best interests of the patient.: that the owner has agreed that they have understood that medicines may be used which are not licensed for use in dogs and cats: and that in the event that you cannot be contacted on the above number, you understand that Northwest MRI & CT will act in the best interest of the patient.

Referring Practice details





PATIENT DETAILS





Area:

HeadThoraxAbdomenLimbsOther




Please bill:

OwnerThe Vets

Attached history:





All reports are delivered to the email address above within 48hours (working) of the scan if you wish an urgent report then it can be done within 4 hours for an extra £90, please ask if wish need any specific details regarding your referral.

PLEASE ENSURE YOUR CLIENT HAS SIGNED YOUR GENERAL ANASTHETIC CONSENT FORM.

NOTE: By submitting this form you confirm that you are a qualified veterinary surgeon who has obtained consent from the patient’s owner to act on behalf of the animal described above: that the owner has given permission for the administration of an anaesthetic/sedative to the above animal at the imaging location together with any other procedures that may prove necessary: and that the owner understands that in the unlikely event of an emergency or where additional pain relief or sedation may be required, the imaging branch will act in the best interests of the patient.: that the owner has agreed that they have understood that medicines may be used which are not licensed for use in dogs and cats: and that in the event that you cannot be contacted on the above number, you understand that Northwest MRI & CT will act in the best interest of the patient.