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PATIENT INFO FORM 
Use this form to add all patients (new or recheck) to your previously scheduled appointment time(s)
**SUBMITTING THIS FORM DOES NOT PUT YOUR CLINIC ON SEVC'S SCHEDULE**
Clinics must first reserve an appointment time on the online scheduler page
 

  • 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, if desired records can be also be attached or emailed to: referrals@sevetcardiology.com.

    • PLEASE DO NOT WRITE "SEE RECORD/RECORDS ATTACHED" or "ask DVM" - all pertinent information to the consultation should be included on the patient info form 

    • If no/limited/incorrect information is provided, SEVC's recommendations may be inaccurate. Fill out a form for every case with current details. 

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  • Additional scheduling details at bottom of page

THIS FORM DOES NOT RESERVE TIME ON SEVC'S CALENDAR

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. Please consider taking deposits to limit cancellations.

    • 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.

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

  • See information about travel and cancellation fees on the scheduler page (at bottom)

  • Any records can be submitted using the link below the patient info form or by emailing them to referrals@sevetcardiology.com

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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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