Submit Your Request Enter all the information below to submit your appointment today. Request Form: Before you submit your form, please Call, Text or Email us to start scheduling your appointment: info@thefocalzone.com Hospital NameIf multiple locations, please state which location Patient's First Name Patient's Last Name ROUTINE OR STAT?*IF STAT, PLEASE CALL IMMEDIATELY TO SCHEDULE. BASED ON SONOGRAPHER/SPECIALIST AVAILABILITY.ROUTINESTAT - PLEASE CALL IMMEDIATELY TO SCHEDULE. BASED ON SONOGRAPHER/SPECIALIST AVAILABILITY.Services Requested*Please check ALL that apply. If this is a STAT read, please call immediately so that your request can be processed. STAT (CALL IMMEDIATELY TO SCHEDULE) Abdominal Echocardiogram Thoracic (Non-Cardiogenic) Double Cavity (Abdominal Plus An Additional Cavity) Other ECG with Cardiologist Interpretation Overseeing Veterinarian Species: Breed: Patient DOB: Patient Gender: Male Intact Male Neutered Female Intact Female Spayed Unknown Patient Weight: Is this a staff member's pet?NoYesClinical Exam Findings:Presentation, Physical Exam, etc. Bulleted text is appreciated. Current MedicationsAny medications patient is currently on, or has been administered in the last 24 hours. ABNORMAL Labwork ValuesPlease list any abnormal lab work values. Example: ALT 400, BUN 47. You can alternatively email them to: info@thefocalzone.com The specialists have recently requested full lab work along with the ultrasound to provide the most detailed case read. Radiographic FindingsYou may send up to 3 CURRENT radiographs that are of the same cavity that is being examined. These will supplement the ultrasound, however the main ddx will be made from the ultrasound itself. Please contact me if you have further questions. Email radiographs to: info@thefocalzone.comPrimary Question to Be Answered in This ExamDo you have an appointment scheduled for this ultrasound already? If so, when? If you DO NOT have a scheduled appointment, PLEASE CONTACT The Focal Zone directly* Email for Submission Confirmation & Contact* CAPTCHA