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CT Request

Complete the form below to request a CT Scan

We can accept CT ONLY scan requests. These appointments will be admitted by one of our CT Nurses and receive a full vet check before sedation/GA but no Referral Vet consultation will be included.

The results of the CT scan will be reported directly to the referring veterinary surgeon, by email, within 2-5 days or sooner if requested.

Please complete our online CT request form.

Outpatient Imaging Request Form

Practice Details

Client Details

Patient Details

Has the patient been neutered?:

Insurance Details

Is the patient insured?:
Has a direct claim been requested?:

Please ask your client to speak to their insurance company and give permission for Vale Referrals to speak to them to confirm/discuss details of their insurance policy on their behalf.

Referral Details

Urgency of the Case:
Area to Scan:

* Multiple areas will incur additional charges. *

 
 
 
A contrast agent is typically used when scanning. Is contrast required?:
Have pre-operative bloods been performed prior to admission?:
 

Attachments

Please attach the appropriate case history and any additional records e.g. test results, radiographs, ECG tracings etc (Max total file size 8MB).
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