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Outpatient CT Request Form

A30 Referrals provides an outpatient CT scanning service. This is a service through which we can carry out a CT scan on your behalf and provide you with a report from a specialist radiologist. With this type of referral, we carry out a basic pre-anaesthetic health check, but we do not carry out a consultation or other investigations, and we do not provide further input into case management. The CT report will be emailed directly from the radiologist to you, so that you can then report the findings to your client and formulate a treatment plan. If this is not the type of referral you require, please telephone us to discuss making a full surgical or medical referral.

Client Details

Species



Body Areas requiring CT











(cost increases with each additional body area)
Is this case


Is this pet insured?

Does this client have an ongoing direct insurance claim in progress?

This text will be passed directly to the reporting radiologist
Security Question
 
 
Please also send us a copy of your full clinical history (including any previous imaging and laboratory work). We will provide an estimate of costs to your client when we contact them to arrange an appointment.