Ultrasound Referral Form

Referring Clinic Information

Clinic Name
Date
Referring Veterinarian
Clinic Email
Clinic Phone

Client Information

Name
Contact
Email

Patient Information

Name
Species
Breed
Sex
Date of Birth
Weight
Microchip

Appointment Request

Requested Provider - Specialist Name
Date
Time
The patient will come with

Procedure Information

Ultrasound Request
Reasons for Referral (Symptoms / Tentative Diagnosis)
Current Medication(s)
Special Request (If there is any)
Important: Turnaround time for full report is 3-5 working days. For immediate request, additional payment will be incurred. Please contact the reception team for further information.
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If you would like to schedule an appointment, please don’t hesitate to reach out to us.

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About us
We pride ourselves on delivering top-tier veterinary care in a welcoming, modern environment. Since 2012, our experienced team has served countless pets across the UAE with compassion and expertise.
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For more information
800 3990
Location
Al Wasl Road, Corner Al Manara, Villa No. 881, Dubai
Email
info@thecityvetclinic.com
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