Referral Form | Submit a Veterinary Imaging Case in Kansas City

What is the clinical question you want to answer with this examination?(Required)

Clinic Name(Required)

Clinic’s Phone(Required)

Doctor's Name(Required)

Doctor's Email(Required)

Doctor’s Mobile Phone(Required)

This number will only be contacted in urgent cases regarding the patient.

Pet Owner's Email(Required)

Pet Owner's Phone(Required)

Patient Name(Required)

Name of Pet

Patient Age(Required)

Age of Pet

Weight (kgs)(Required)

Temperament(Required)

Chief complaint?(Required)

Space for a longer history is provided below, but it helps us greatly if you can provide a reason for this referral in one sentence.

Please upload patient's history and lab results

Drop files here or

Max. file size: 128 MB.

***VERY IMPORTANT, PLEASE READ*** Please upload the full patient history and bloodwork using the “choose file” button above. If your files are very large (over 100mb), please reach out to us at info@arrow-di.com. You can also paste a share link in the box below.

Where should we email the REPORT?(Required)

Additional emails to send REPORT

VERY IMPORTANT – Sometimes email addresses are misspelled and our reports are lost or delayed getting to the right person. When in doubt, please enter additional email addresses here, separated by a comma. For example “info@vetclinic.com, drsmith@vetclinic.com, drjones@vetclinic.com.” In the previous example we will email the report to all three locations.

Arrow Diagnostic Imaging is committed to protecting and respecting your privacy, and we’ll only use your personal information to administer your account and to provide the products and services you requested from us.

By clicking submit below, you consent to allow Arrow Diagnostic Imaging to store and process the personal information submitted above to provide you the content requested.

How to Refer

Ready to Partner?

Patient History