Book CT outpatient referral

Please use the form below to use our outpatient CT services (Referring Veterinary Surgeons Only). Alternatively this form can be downloaded HERE and faxed or emailed to us.

Practice Details

Client Details

Animal Details

Has blood testing been performed within the last two weeks? YesNo

If so, please attach/email or fax results. Attach a File
File formats accepted: PDF, DOC (4MB or less)

Contrast Required? YesNo
If uncertain, please contact us for advice.

Would you like to speak to one of our Vets before we arrange the appointment with the client?YesNo

How would you like to receive your report? FaxEmailPost

Would you like us to invoice you (the referring practice) directly? YesNo

Please note that if you would like us to acquire payment directly from the client we require payment in full on the day of scanning.