This form will be MANDATORY for all outpatient service offered by radiology to help ensure that we are assisting in the care of your patient in the best way possible. We also ask that you return this form with the below items wich can be sent by email to records@dvms.vet or by fax to 480-892-0540. If records are not received 2 days prior to appointment we may reschedule the patient's appointment to be able to best serve the client and patient. Results of all outpatient procedures will be sent to you to plan follow-up treatment.

UPDATE: to best meet the client/patient needs we will only schedule outpatient ultrasounds with clients once we receive this form along with the listed items below.

• Last 12 months of medical records

• Last 12 months of labs

• Any radiographs and/or report

• Any other information you may find pertinent to the patient's medical needs/concerns