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Labwork Submission for Existing Referral
Radiograph Submission-Existing Referral
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Complete your Radiograph Submission – Existing
Referral
form online!
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This form was submitted by:
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Referring Clinic:
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Email address you would like the HCVSS Dr. reply sent to:
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Referring DVM
*
Patient Name
*
First
Last
Is this patient's surgery scheduled with HCVSS?
*
Yes
No
If yes, what day is it scheduled for?
Is there a physical marker in your radiographs?
*
Yes
No
Notes
Please attach Radiogaphs here. These must be in JPEG format.
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You can upload up to 10 files.
JPG
Additional Comments:
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