ECG Consultation Request

When referring your patient to our hospital, please complete this form along with all pertinent medical records.

 

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REFERRING VETERINARIAN INFORMATION

CLIENT INFORMATION

PATIENT INFORMATION

STUDY INDICATION

Is there a non-IDEXX report from a previous study available for comparison? *


If yes, please upload a PDF of the report at the bottom of this form.

Please select the indications or clinical signs that prompted this study *










HISTORY

Currently the patient's appetite is reported to be: *


PHYSCIAL EXAM

Cardiac rhythm *

Which of the following best describes the patient's attitude/demeanor? *






Any recent changes in body condition? *



DIAGNOSTICS
 

Do you need comments on anesthesia for a procedure planned in the short-term future? *

UPLOAD FILES

Security Question *
 
 

Practice information

Tuxedo Animal Hospital

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  • Mon
    8:00 am - 6:00 pm
  • Tue
    8:00 am - 7:00 pm
  • Wed
    8:00 am - 7:00 pm
  • Thu
    8:00 am - 7:00 pm
  • Fri
    8:00 am - 6:00 pm
  • Sat
    8:00 am - 2:00 pm
  • Sun
    Closed

After-Hours Emergencies

Please call:

204-452-0911
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Find us here:

192 – 2025 Corydon Avenue Winnipeg, Manitoba, R3P 0N5
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For after-hours emergencies, please call:

204-452-0911