Clinic Name *

Referring Doctor's Name *

Response Email *

Reason for radiograph submission? *

If other, please explain:

Patient Name *

Patient Age, Weight, and Breed *

Pertinent physical exam findings and medical history. *

Upload Documents

Click or drag files to this area to upload. You can upload up to 10 files.

JPEG, Doc, Docx, PDF, PNG, JPG. Please do not upload zip files
JPGs must be minimum size of 1500px - 2500px
Please remove any special characters in the file name before you upload: examples ^,$

Pet Radiology

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