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PATIENT INFO FORM 
Use this form to let SEVC know about all patients (new or recheck) you wish to be evaluated during your scheduled consultation time
**To schedule a consultation, first use the online scheduler page. SUBMITTING THIS FORM DOES NOT PUT YOUR CLINIC ON SEVC'S SCHEDULE**

  • Ideally, these forms are filled out by the veterinarian or a medically-trained staff member who knows details about each case. 

    • ​Due to the lack of time available to review records at the clinic during each consultation, please fill this form out in its entirety with pertinent details for the consultation, as well as attach below or email any records pertinent to the cardiology consultation (referrals@sevetcardiology.com).

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  • If no/limited information is provided, SEVC's recommendations may be inaccurate. Please do not write "see record" or "ask DVM", all pertinent information should be written in the patient info form

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  • Additional scheduling details at bottom of page

THIS FORM DOES NOT RESERVE TIME ON SEVC'S CALENDAR

If your clinic does NOT have a previously scheduled SEVC consult time, please click here to schedule consultation time FIRST.   

SPECIES
NEUTERED/SPAYED?
GENDER

Email any radiographs (or medical records) to:

referrals@sevetcardiology.com

Upload Records 1
Upload Records 2

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 ADDITIONAL INFO:​

  • Up to FOUR cases can be evaluated per 90 min consult time

    • Keep track internally (on your clinic's own schedule) of what and how many cases are being scheduled for your clinic per consult time. Each clinic is responsible for scheduling/confirming dates with clients

    • SEVC will have record of what cases are to be seen each day based on referral form submissions, but again, each clinic should keep track of this as well.

    • If a change in medication dosing or clinical signs/condition occurs after submitting the info form, please update SEVC - otherwise we will not know about these changes

  • Please note that the online scheduler and patient info forms are separate. The online scheduler creates the time reservation only - it is not involved with patient submission. The patient info form is just to provide information for each patient you wish SEVC to evaluate during the reserved time.

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  • ***Email will be the primary method used to confirm/adjust consultations - please include a monitored, general clinic email address to prevent delays.*** 

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  • Travel Fee - will be applied if only one case is evaluated during the consultation. Scheduling two or more cases will remove any travel fee. Consider using deposits to limit cancellations of multiple cases.​  ***Please see service area page for travel fee pricing***

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  • Cancellation Fee - May apply if only one case is scheduled and then cancels within 1 business day prior to consultation, or no-shows. This includes Friday cancellations for Monday consultations

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If you are a pet owner: please contact your primary care veterinarian to have them schedule a cardiac evaluation in their hospital with SEVC.  

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