CT Imaging Request

Please complete this form if you would like to refer a patient to us for a CT.

Practice Details

Patient and Owner Details

Case Details

Receipt of Report:

Security Question:

This is an outpatient service and Boness Vets will only perform the CT scan as requested above. No other treatment other than that in an emergency will be carried out. The charges include the CT scan, anaesthetic, pre-anaesthetic bloods, peri-operative fluids, use of contrast and the issue of the report. Please ensure the owner is aware of the costs.

Please guarantee all information on this form is correct and accurate to avoid delays. Please send this completed form along with the patient’s clinical history to bonessvetsct@boness-vets.co.uk
Once we have received the request, we will contact the owner to book and then contact the practice to confirm the booking. Please note that our standard turnaround for CT requests is 7 days.