Referring CT Scan Form

Referring your client to Taconic Veterinary Center is easy, just fill out the form below or call us at 914-737-2437.

Pet Name *

Client Name *

Client Primary Phone # *

Client Secondary Phone

Referring Doctor's Name *

Referring Clinic

Referring Doctor's E-Mail *

Patient Chief Complaint or Problem

Patient History and Findings

Reason for CT Scan

What region of body to needs to be scanned?

What are the patient's current medications and doses?

Are there any known allergies?

Have medical documents you need to send us? Upload them here.

Maximum upload size: 52.43MB

Walk-in or request an appointment online