Radiographic Interpretation - Minnesota Veterinary Dental Specialists

Patient's First Name*

Species*

Breed*

Gender*

FemaleMaleFemale/SpayedMale/Neutered

Age*

If unknown, please estimate

Owner Last Name*

Owner First Name

Optional

Requester's Name*

PrefixFirst NameLast Name

Practice Name*

Practice Phone Number*

Requester's Email*

example@example.com

Upload images (radiographs and/or photos) you would like to send for interpretation. If submitting more than one, hold the Ctrl button down while clicking all the images you want to send.

Please note: All images must be in jpeg format. Please contact your imaging software technical support for details.

Please provide a detailed patient history, including clinical symptoms, clinical appearance of a tooth or teeth in question, and any specific concerns or questions you would like answered.*

Include onset and duration of symptoms

Turnaround times are valid only when the practice is open and does not include weekends or holidays.

I understand the details of turnaround times as described above**

Agree

A written report will be sent to the email address you provided within the time indicated.

Choose from below:*

Standard Radiographic Interpretation (3-4 day turnaround time)

$71.50

Priority Radiographic Interpretation (within 48 hours)

$90.00

Total

$0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code (for non-USA Territory, use the three numerical digits of your Canadian Postal Code followed by "00". Example: A2B 3C4 = 23400

Country