Forms for Veterinarians

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:

Please fill out your form online.

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

Referral Form

This form is for primary care veterinarians referring patients to be seen by one of our specialists in our Gainesville, FL location.

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

Please fill out your form online.

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 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:

Please fill out your form online.

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:

Please fill out your form online.

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:

Please fill out your form online.

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 either a telephonic or digital ECG device. Please contact our office for more information on the differences between these two devices.

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

Please fill out your form online.

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:

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