Appointment Date/Time *

Date

Time

COVID precautions are in effect.

Owner will not be able to enter the clinic. Call 902-468-0674 when you arrive. Ultrasounds will be performed at Metro Animal Emergency Clinic (MAEC) at 201 Brownlow Ave #32, Dartmouth, NS. All images will be sent for interpretation by a Board-Certified Radiologist.

All patients must be fasted for a minimum of 8 hours prior to the procedure. Ultrasound cannot be performed otherwise. Please arrive 30 mins prior to your appointment time to check-in.

All patients will be sedated for the procedure unless they are critically ill, or moribund. (sedation fee is separate and will depend on the size of the pet).

An estimate will be given and fees for an ultrasound will be paid to MAEC at the time of your appointment.

The procedure takes approximately 3 hrs. Recovery times vary and we will communicate to you when your pet is recovered.

**Results will be attached to our files then emailed to your regular veterinarian when they arrive. Your regular veterinarian will communicate results to you. **

Referring DVM *

First

Last

Clinic *

Clinic Email *

Client Name *

First

Last

Client Phone *

Client Email *

Client Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Patient's Name *

Species *

Dog
Cat
Other

If other, please specify: *

Breed *

Age *

Sex *

Male
Male (neutered)
Female
Female (spayed)

Weight *

Required Documentation:

Any recent bloodwork or diagnostic testing
Most recent SOAP
Other relevant medical history

Service requested: *

Standard (3-5 days)
Priority (24 hrs)
Stat (2 hrs)

Signature *

Ultrasound Referral Form

We are open Thursdays 6pm until 8am
Fridays 6pm until Monday 8am

Call before your visit.

Email

Address