Insight Imaging Schedule Request
Michael Wasserman DVM, SDEP® Certified Sonographer (Abdomen)
Expect appointment confirmation within 30 minutes during normal business hours. For same-day requests, please call before submitting to confirm availability.
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Hospital Name
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Requesting Doctor
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Last Name
What ultrasound request is this?
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Please Select
Abdominal US w. Abdominal Specialist
Echocardiogram w. Cardiologist Read
Double Cavity US w. Cardiologist Echo
Please select a drop down, Please note the small parts study requested in the history below.
Email address to send confirmation
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example@example.com
Would you like this study read STAT within a 3-6 hour turnaround time? Weekend STAT echocardiograms/double cavities will be read by a DABVP specialist and generate a complete report within 4-6 hours.
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Yes - STAT (+$50/cavity)
No - Routine turnaround - 24hrs
Patient Information
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First Name
Last Name
Age
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Years
Sex
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Please Select
Intact Female
Intact Male
Male Neutered
Female Spayed
Species
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Please Select
Canine
Feline
Other
Select a dropdown
Breed
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Weight
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Lbs
Please provide a relevant clinical history, recent pertinent laboratory values (at least abnormal values), current medications, and any information related to the primary reason for this ultrasound.
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0/1600
Please attach radiographs, radiologist reports, ECG interpretations, or other supplemental information by dragging files here or clicking here. For echocardiograms, please include any radiographs with this submission to ensure timely reporting. Radiographs attached here are guaranteed to be included with the Echocardiogram submission for supplemental review.
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