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Is the patient stable?
Yes
No
Critical condition?
Yes
No
Referring Clinic Information
Please email radiographs to:
customercare@ntepc.com
Referring Clinic Name
Referring Veterinarian
Phone (*Please list all contact numbers)
Email
Fax
Preferred Contact
Email
Fax
Client Name
Patient Name
Client Phone
Medications (Time / Dosage / Route)
Tentative Diagnoses
Diagnostics Performed (please list)
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