PATIENT INFO FORM 
Use this form to add patients to a scheduled consultation time at your clinic
(includes adding a new patient to a previously scheduled reservation)

 

Please provide pertinent historical details and current medication information below for each patient to be seen during the consultation time (including dose and frequency info) to help SEVC give the most accurate assessment of your case. Ideally, these forms are filled out by the veterinarian or a medically-trained staff member who knows details about each case.

If your clinic does not provide a detailed history, recommendations may not be accurate.

 ADDITIONAL INFO:

  • Up to THREE 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 - your cases submitted via the patient info form will not populate into the online scheduler. The online scheduler creates the time reservation only. The patient info form is just to provide information for each patient you wish SEVC to evaluate during the reserved time.

  • Include detailed pertinent history and current medications with dosing amount/frequency

    • Without this, SEVC cannot give accurate recommendations

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

  • Travel Fee - will be applied for consultation times with only one case. Scheduling two or more cases will remove any travel fee.   ***Please see service area page for new travel fee pricing as of 3/15/22***

  • Cancellation Fee -  may also apply if only one case is scheduled and cancels within 24 hours prior to consultation, or no-shows.

 

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

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

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Email any radiographs (or medical records) to:

referrals@sevetcardiology.com

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If desired, another case can be added at this time or you can come back later