Diagnostic Imaging Request
Palm Veterinary Imaging, LLC
Clinic
*
Garden Veterinarian
*
Please Select
Dr. Berger
Dr. Linblad
Dr. Schoppert
Dr. Stroud
Heading
Email
example@example.com
Williamsburg Veterinarian
*
Please Select
Dr. Dosher
Dr. Hayes
Pet's Last Name
*
Pet's First Name
*
Birthdate
*
-
Month
-
Day
Year
Date
Species
*
Canine
Feline
Breed
*
Sex
*
Female Intact
Female Spayed
Male Intact
Male Neutered
Patient History
*
The provided text is included in the report.
Service Requested
*
Teleradiology
Mobile Ultrasound
Please send study.
Instructions to send images can be found below, if needed.
Manual send from IDEXX Web PACS
Manual send from IDEXX desktop PACS
Auto-routing from IDEXX Desktop PACS (sends all studies)
Direct from imaging equipment
File upload to server
Instructions for initial set-up of IDEXX Web PACS & Desktop PACS
Please do not forget to submit the form at the bottom of this page.
Make an appointment for mobile ultrasound by selecting the desired date below. Please do not forget to submit this form at the bottom of the page after
Submit
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