MRI Referral Form

Medical Condition:
1. Please supply documentation of vaccine status and heart worm testing.*
2. Please supply thoracic radiographs and biochemistries and CBC per-formed on the patient within the past 30 days. This is necessary prior to anesthesia.*
3. Please supply any pertinent history or medical information.*
*Requested information may be sent with the owner or by email at mri@vcsmilford.com.
Should this be treated as an outpatient procedure with the patient discharged to return to your hospital once recovered from the procedu-re?
Exam Ordered:
MRI [please specify with (w) or without (w/o) contrast for site chosen]
Please specify any additional information or requests be-low:

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We Focus
on total pet care

24 HOUR EMERGENCY

AND CRITICAL CARE FOR YOUR PET
 
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Veterinary Care Specialists

 
 
24 H / 7 Days
 
205 Rowe Rd Milford, MI 48380
Click here for driving directions to our office.
 
248.684.0468
 
Fax: 248.685.8122
 
vcs@vcsmilford.com
Customer Care 248 684 0468
24 hours a day, 7 days a week, 365 days a year for you