Saint Francis Veterinary Specialists

 

 

 

Date:
Priority:
DVM Name:
Hospital Name:
Hospital Street Addr:
Hospital City & Zip:
Hospital Phone:
Hospital Fax:
DVM Email:
Has Patient Visited SFVS Previously?
Pet Owner Name:
Owner Home Ph:
Owner Work Ph:
Owner Cell Ph:
Owner Email:
Pet Name:
Pet Age:
Pet Gender:
Pet Weight:
Pet Breed:
Vaccine History & Dates:
Pet Behavior:
Brief History:
Laboratory Work:
Radiographs:
DIGITAL: Images being sent on disk
DIGITAL: Dicom images will be sent via online server connection

PLEASE NOTE:

The medical record and laboratory work may be faxed to 404-974-2006. Please send any radiographs and/or DICOM digital images on a CD/DVD with your client. You may transmit digital (DICOM) radiograph files via your PACS server directly to our PACS server. For help with PACS connectivity and file transfer, please contact Tommy Meers at 404-924-2000, ext.108. Please ensure that all images sent to SFVS are labeled with the patient name and hospital name. Please retain a copy of your CD/DVD discs, since these are not typically returned to the referring veterinarian.