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Home
TeleCardiology Follow-Up Consultation Request
Do you need a follow-up phone or email consultation for a patient who has already visited TeleCardiology by CVCA?
*
Yes
No
Please fill out our
Refer a Patient Form
instead.
Has the patient seen us in the past 30 days?
*
Yes
No, it has been over 30 days
Price range for consultation
The cost associated with this service is $50. A cardiologist will reach out within 48 hours.
Owner Name (First and Last)
*
First
Last
Owner Phone Number
*
Patient Name
*
Primary Care Veterinarian's Name:
*
Primary Care Practice Name:
*
Veterinarian Requesting Consult
Follow-up preference to your office
Call
Email
Best email to forward results:
*
What type of consultation do you need?
New bloodwork consultation
New radiographs consultation
New ECG consultation
Discuss new medications/change in medications
Other
Please write below any specific comments or questions you may have for the cardiologist.
Documents (Upload here or email)
If you have questions regarding labs, radiographs, or other tests, please upload those documents here OR send via email to your CVCA office.
Bloodwork
Bloodwork
Max. file size: 30 MB.
What type of bloodwork have you uploaded/are you sending to CVCA?
*
Radiographs
Radiographs
Max. file size: 30 MB.
Radiographs (Description)
*
I have uploaded radiographs here.
I have emailed radiographs separately to my chosen CVCA location.
Radiographs available on shared internal server
Radiographs are on film
Type of Radiographs?
*
Chest Radiographs
Abdominal Radiographs
Additional Documents
File
Max. file size: 2 MB.
File
Max. file size: 2 MB.
File
Max. file size: 2 MB.
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