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Forms for Veterinarians

Telemedicine Forms

Patient Information Form
Mobile Request Form
Monitor Request Form
Enrollment Form
ECG Device Request Form

Referral Forms

Referral Form
Dentistry Referral Form
Imaging Referral Form
Upload Forms

Patient Information Form

This form is used to briefly summarize a patients’ pertinent history for Telemedicine clients. It is to be submitted for Telemedicine cases.

Please fill out your form by choosing one of the following options:

Online Patient Information Form

Please fill out your form online.

Referral Form

This form is for primary care veterinarians referring patients to be seen by one of our specialists in our Gainesville, FL location. This is not for Telemedicine cases.

Please fill out your form by choosing one of the following options:

Online Referral Form

Please fill out your form online.

Print Referral Form

Please print your form using the button above. Once you have filled it out, please upload the form.

Dentistry and Oral Surgery Referral Form

This form is for primary care veterinarians referring patients to be seen by a Board Certified Veterinary Dentist in our Gainesville, FL location.

Please fill out your form by choosing one of the following options:

Online Referral Form

Please fill out your form online.

Print Referral Form

Please print your form using the button above. Once you have filled it out, please upload the form.

Imaging Referral Form

This form is for primary care veterinarians referring a patient for one of our imaging services (CT and MRI) in our Gainesville, FL location as an Outpatient Service. All billing and communication will go through the primary care veterinarian.

Please fill out your registration form by choosing one of the following options:

Online Imaging Referral Form

Please fill out your form online.

Print Imaging Referral Form

Please print your form using the button above. Once you have filled it out, please upload the form.

Enrollment Form 

This form is to enroll in our Telemedicine Services. There is no fee to enroll and at enrollment you will receive your first 3 preoperative and 3 routine cardiology reports free as part of a trial package.

Please fill out your registration form by choosing one of the following options:

Online Enrollment Form

Please fill out your form online.

Print Enrollment Form

Please print your form using the button above. Once you have filled it out, please upload the form.

Monitor Request

This form is for primary care veterinarians to request either a Holter monitor (24 hour) or a cardiac event recorder (CER) for application at their office.

Please fill out your registration form by choosing one of the following options:

Online Monitor Request Form

Please fill out your form online.

Print Monitor Request Form

Please print your form using the button above. Once you have filled it out, please upload the form.

ECG Device Request Form

This form is for Telemedicine clients to request a digital ECG device. 

Please fill out your registration form by choosing one of the following options:

Online ECG Device Request Form

Please fill out your form online.

Print ECG Device Request Form

Please print your form using the button above. Once you have filled it out, please upload the form.

Mobile Request Form

This form is for primary care veterinarians in Central and North Central Florida to request in clinic cardiac and internal medicine consults for their patients.

Please fill out your registration form by choosing one of the following options:

Online Cardiology Mobile Request Form

Please fill out your form online.

Printable Cardiology Mobile Request

Please print your form using the button above. Once you have filled it out, please upload the form.