Please use this form to submit a referral request to NC State Veterinary MRI.This service is for veterinarians only – clients seeking medical information should contact their regular veterinarian for assistance. If you would like to make a referral to one of the VH Services and you do not need to talk to a VH clinician, you can use this form to submit the client and patient information. Please indicate on the form if you have told the client to call the VH, or if you would like us to call them. Please provide a summary of the history of the case so that we can be prepared to provide the patient with the appropriate care. Please send or fax supporting information. Please send radiographs or other images with the client or by submitting directly to us through eFilm (see instructions on main Information for Referring Veterinarians page).
NOTE: The NC State Veterinary MRI only accepts American Society of Anesthesiologist Status I & II patients for outpatient referral. Upon receiving referral information and medical records as outlined below, an ASA determination will be made by the Anesthesiologist. For optimal medical care and patient management, ASA III – V patients must be referred through primary VH services (e.g. Neurology, Internal Medicine, etc). American Animal Hospital Association Preanesthetic Evaluation Human ASA Physical Status Classification SystemIf this is an EMERGENCY REFERRAL (i.e. needs to be seen within 24hrs), please call the appropriate service immediately after submitting the information below.