Refer a Case for CT Imaging Simple, Fast CT Referrals for Veterinary Practices Home Referrals Start a Referral CT Referral Form CT Scan Referral Form Step 1 of 4 - Contact Info 25% LinkedInThis field is for validation purposes and should be left unchanged.Referring Vet DetailsReferring Practice(Required)Vet Name(Required)Contact Number(Required)Email(Required) Patient DetailsAnimal Name(Required)Species Dog Cat Other Breed(Required)Sex(Required)Male entireFemale entireMale neuteredFemale neuteredUnknownAnimal Age(Required)Weight (kg)(Required)Owner DetailsOwner Name(Required)Phone Number(Required)Email(Required) PaymentPayment will be covered by: Invoice to Referring Practice Client to Pay Clinical HistoryReason for referral for imaging(Required)Relevant Medical History / Previous Conditions(Required)Current Medications(Required)Allergies or reactions to medications(Required)Brucella risk?(Required)Disclaimer for Brucella - our practice policy Yes No Please give specific information on Brucella risk:(Required)Behaviour(Required)Friendly, muzzle necessary, other: please specify CT Request DetailsAreas to be scanned(Required) Head Neck Thorax Abdomen Spine Forelimbs Hindlimbs Forelimbs – Specific Areas(Required)Each selection counts as one area Elbows Bilateral Carpus Shoulders Are you interested in just the bones or surrounding soft tissues?(Required)If both, contrast will be required for a better image Bones Soft Tissues Hindlimbs – Specific Areas(Required)Each selection counts as one area Hips Tarsus Stifles Are you interested in just the bones or surrounding soft tissues?(Required)If both, contrast will be required for a better image Bones Soft Tissues Whole body or multiple areas - which is your main area of interest/priority?(Required)(This is important for us to know if we are using contrast)With Contrast?(Required)Required for scans of both bones & soft tissue Yes No AnaesthesiaFit for General Anaesthesia?(Required) Yes No Unsure Finalise ReferralFurther information or notesUpload HistoryUpload relevant patient history and files here. Drop files here or Select files Max. file size: 128 MB. Please check the box below to indicate you give us permission to obtain medical history for any relevant pets(Required) I accept Keep up to date about our referral services?(Required)We would love to keep you informed about our range of referral services, including case studies and new developments. You can sign up for updates here. You can opt-out at any time. Please read our Privacy Policy for further information. Yes please! No thanks CAPTCHA Not ready to refer? No problem — enquire today and our team will be happy to talk you through our referral services, answer your questions, and explain how we could support future cases. Enquire Here Need advice?If you have any questions regarding a CT referral, please contact 02922 520 471 or email ct@livewellvets.co.uk