THE BARN DOOR VETERINARY CARE-Abdominal Ultrasound referral form

Referral: Please fill out the form below. If you have any questions, please contact us directly at (604) 227-3111 or email info@barndoorvet.ca.

Purpose: To provide timely, high-quality Abdominal Ultrasound services to support local veterinary practices while maintaining the referring veterinarian's role as the primary care provider. Scope of Service:

Policy: Outpatient abdominal ultrasounds are performed by a trained veterinary professional and include the radiologist interpretation via ANTECH. No treatment, diagnosis, or case management will be provided by The Barn Door. All communication and medical records will be directed to the referring veterinarian.

1. Referring clinic completes the Referral Request Form

2. Barn Door reviews the case to confirm it falls within scope

3. If accepted, the client is contacted directly to schedule the ultrasound

4. On appointment day, the patient is received by Barn Door staff; the client does not enter the facility

5. Ultrasound is performed and submitted to ANTECH

6. Final report is sent directly to the referring veterinarian

7. The referring clinic remains responsible for all client communication, diagnosis, and treatment.

The Barn Door will not discuss findings, treatment options, or case management with the client All questions and follow-up care are directed back to the referring clinic

Reports are typically returned within 24-48 hours of the appointment. Reports can be done on a STAT basis (4 hours turnaround time) for an extra fee.

Collaboration Philosophy: We are committed to supporting local practices through transparent, respectful partnerships that prioritize patient care and preserve the integrity of the client-veterinarian relationship.

Please fill out and submit the form below:

Referring Clinic Name*

Referring Veterinarian*

Email*

example@example.com

Phone *

example@example.com

Patient Name*

Species*

Breed*

Age*

Weight*

Sex*

Pre-Visit Pharmaceuticals (PVP's)-Will you be providing PVP's to your patient for this procedure (Y or N?) If yes, please provide dosage(s). *

Owner information

Owner Name*

Phone*

Format: (000) 000-0000.

Email*

example@example.com

Clinical History & Reason for Referral

Presenting complaint*

Relevant history*

Current Medication

Specific area(s) of concern for the Ultrasound

Attachments required. Please email us the most recent medical notes, relevant lab work, radiographs to: info@barndoorvet.ca

Note: Urgent (within 4 hours - STAT fee will be applied) Routine is (24-48 hours)

By submitting this form, I confirm that I am the primary veterinarian for this patient and authorize The Barn Door Veterinary Care to perform an outpatient abdominal ultrasound. I understand that all results will be sent directly to our clinic, and that Barn Door will not provide treatment or case management.

Signature

Date

Outpatient Abdominal Ultrasound