To make the process as efficient as possible, please fax or e-mail all current bloodwork, imaging and lab reports relevant to this case in advance of your appointment. Fax (802) 773-0485 or info@rutlandvet.com. If you have any questions please feel free to call us at (802) 773-2779. Thank you.

PRACTICE INFORMATION

Referring Practice *

Address

Address Line 1

Address Line 2

City

State

Zip Code

Referring Veterinarian *

Practice E-mail *

Practice Phone *

PATIENT INFORMATION

Owner's Name *

First

Last

Phone *

Pet's Name *

Birthday/Age *

Species *

Dog
Cat

Breed *

Gender *

Male
Female

Neutered/Spayed *

Yes
No

Is this pet fractious? *

Yes
No

Is it safe for this pet to receive full sedation? *

Yes
No

Chief Complaints

Current Medications

Medical History

PE Findings

Clinical Diagnostics/Results

Differential Diagnoses/Organs of Interest

Which cavity is to be scanned? *

Abdomen
Cardiac

PRACTICE INFORMATION

PATIENT INFORMATION

Ready for a visit?

Find Us

Our Hours

Get in Touch

Have a question?

We’re here to help.