Refer a Patient Patient Referral Form Outpatient Ultrasound Referral Form Radiograph Consultation Referral Form Patient Referral Form Outpatient Ultrasound Referral Form Radiograph Consultation Referral Form Referral Partner Portal Radiograph Consultation Referral FormMedVet Location(Required)Select HospitalMedVet CincinnatiMedVet ColumbusMedVet DaytonMedVet IndianapolisMedVet New OrleansMedVet PittsburghMedVet ToledoWestVet BoiseToday's Date(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920MedVet Cincinnati 3964 Red Bank Road Cincinnati, OH 45227 Main: 513.561.0069 Fax: 513.808.4042 Email: referrals-cincinnati@medvet.com MedVet Columbus 300 E. Wilson Bridge Road Worthington, OH 43085 Main: 614.846.5800 Fax: 614.547.6689 Email: referrals.columbus@medvet.com MedVet Dayton 2714 Springboro West Moraine, OH 45439 Main: 937.293.2714 Fax: 937.293.2787 Email: appts.dayton@medvet.comMedVet Indianapolis 9650 Mayflower Park Drive Carmel, IN 46032 Main: 317.872.8387 Fax: 317.552.0919 Email: general.indy@medvet.comMedVet New Orleans 2315 N Causeway Boulevard Metairie, LA 70001 Main: 504.835.8508 Fax: 504.835.8509 Email: referrals.nola@medvet.comMedVet Pittsburgh 2810 Washington Road McMurray, PA 15317 Main: 724.717.2273 Fax: 724.638.8318 Email: info.pittsburgh@medvet.comMedVet Toledo 2921 Douglas Road Toledo, OH 43606 Main: 419.473.0328 Fax: 419.960.0503 Email: referrals.toledo@medvet.comWestVet Boise 5024 W. Chinden Blvd. Garden City, ID 83714 Main: 208.375.1600 Fax: 208.375.1606 Email: clientcare@westvet.net Please Note: WestVet does not provide CTs or MRIs as outpatient services. Please prepare your patient for a consult with one of our specialists. Your hospital will be invoiced for a radiology review and report fee.Referring Clinic InformationReferring Veterinarian(Required)Clinic / Practice Name(Required)Phone(Required)FaxEmail Address(Required) Client & Patient InformationClient Name(Required) First Last Client Phone(Required)Patient Name(Required)Species(Required) Canine Feline Other Sex(Required) M MN F FS Breed(Required)Age(Required)Color(Required)Patient WeightPatient TemperamentRadiographs Submitted?(Required) Yes No Digital or Analog? Digital, Sent to DICOM Digital, on CD Analog, Mailed Analog, Sent with Owner Digital or Analog? Digital, Sent to DICOM Digital, on CD Digital, Attached to this Referral Analog, Mailed Analog, Sent with Owner Study InformationArea of Interest(Required)Study Date(s) & Number of Images(Required)Referral InformationReason for Referral / Primary Complaint(Required)Clinical Exam / Pertinent Labwork Findings / Working Diagnosis(Required)Specific Questions Regarding RadiographsUpload Files Drop files here or Select files Max. file size: 50 MB. Accepted file types: jpg, gif, png, docx, pdf.Final radiology consultation reports are typically available within one business day from the date they are received by the radiology department. If you are mailing analog images, please allow two-three additional business days for us to receive the images in the mail. Please contact our radiology office if there is urgency in receiving the results so that we may prioritize your consult. If you do not receive a report within the expected timeframe, please do not hesitate to contact the radiology office to ensure your consult has been received.