Radiology Referral Form

Veterinary Teaching Hospital
Attn: Radiology
245 Duck Pond Drive
Blacksburg, VA 24061
Email: vtimaging@vt.edu
Phone: 540-231-4628
Fax: 540-231-9238

Client Information

Patient/Animal Information

Referring Veterinarian / Clinic Information

Patient Case History

Attachments / Additional Records

Have additional images or records been sent electronically?
Have additional records been faxed?
Attach Files / Images