Advanced Imaging Form

Outpatient CT

For stable patients, we offer an out-patient imaging only referral service for CT (Monday-Friday) excluding bank holidays. This service does not include a referral consultation or interpretation of findings. Imaging reports are sent directly to the referring practice. We are not able to carry out any additional diagnostic tests or accept unstable patients. These cases require a full referral.

If you have any questions about the most suitable imaging modality then please email enquiries@cedargrovevets.com, or speak to our referrals co-ordinator on 028 798457.

Reporting times:

Standard - 4 to 7 business days
Enhanced - 2 business days
Priority - 24 hours

Practice Details

Owner Details

Patient Details

Neutered:

Referral Details

Is an urgent report required?:


Please note that additional fees are charged for non-standard reporting
Have pre-anaesthetic bloods been performed prior to admission?:

Imaging Request

Imaging Details:

Body Areas - Additional charges will apply to multiple areas:











Image Safety Questionnaire

Heart disease / pacemaker:

Renal disease:

Known adverse reactions to medications:

Surgery within the previous two months:

Metal fragments / implants any location:

Pregnancy:

Endocrine disease, bleeding disorder, neoplasia:

Epilepsy:

Financial Details

Do you require an estimate prior to referral?:

Insured?:

Security Question: