Thank you for entrusting your patient in our care. In order for the MRI team to perform the scan safely, we ask you to kindly provide all patient details and complete the safety questionnaire below. If you have any questions about the form or further questions about the MRI, please reach out to Susan Proctor, our Chief Radiographer via the reception team (02) 9436 4884. Susan is happy to talk you through the questions and help you narrow down to the correct area to scan.

Thank you for referring your patient to the NSVSC MRI service. Can the referring vet answer all questions, provide details and sign where necessary.

Provide details

1. Has the owner given consent to the patient being anaesthetised and an MRI study to occur at NSVSC? *
2. Does the owner request for resuscitation if required? *
3. Has a patient history been sent to NSVSC? *
4. Have recent blood tests including creatinine and PCV/TP been performed in the last 6 weeks and the results sent to NSVSC? *
5. Has the collar been removed from your patient? *
6. Have all external metal objects been removed from the patient? *
9. Does the patient or has the patient had a contagious disease in the last 14 days? *

Has your pet ever had any of the following;

Heart Surgery? *
Metal implanted in their eye or skin? *
Brain Surgery? *
Any surgical implants? *
Ear surgery? *
Pacemaker? *
Pacing wires/defibrillator? *
Metal pins/plates/rods/screws? *
Had surgery in the last 6 weeks? *
Any other form of implant? *
Allergies *
Shrapnel or bullet wounds? *
Eaten unusual objects? *
Intravascular coil/stent? *
Is your patient pregnant? *

THIS FORM MUST BE COMPLETED BY REFERRING VETERINARIAN AND RETURNED TO NSVSC PRIOR TO THE REQUESTED SCAN.

Spine
Brain
Musculoskeletal
Head

After your submission, we will contact your client to schedule an appointment and provide them with an estimate. If you are wanting to provide an estimate for our services before referring to us, please reach out to our friendly reception team on (02) 9436 4884.