Cardiology: Pre-breeding Holter Monitor Request

Prebreeding and Genetic Packages will only include technician analysis (no cardiologist Interpretation)

The Holter monitor will be shipped priority overnight via FedEx to the address provided below. Holter monitors must be returned within THREE business days of receiving it. Please provide the best date for you to receive the monitor so that it can be placed and returned within that time period. The animal will need to be shaved in five small patches on the chest for electrode placement.

I acknowledge this service is for pre-breeding purposes only. These are diagnostic, tech-read holters with no cardiologist interpretation or recommendations and cannot be used as an assessment for therapy initiation or to monitor therapy response. Dogs with known cardiac issues, history of collapse, or currently taking cardiac medication will not be accepted.

Patient Information

Dog Registered Name (if applicable)

Dog Call Name

Breed(Required)

Owner Name(Required)

First Last

Desired Date to Receive Holter Monitor

Sex

Age

Weight

Additional Notes (Optional)

Shipping Information

Name of Veterinary Clinic (if shipping to veterinary clinic)

Recipient Name

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Order Type

$110.00 – Holter Rental – Technician Analysis Only (NO Cardiologist Interpretation)

$90.00 – Each Additional Dog

Price includes shipping both ways, supplies, and Technician Analysis. Package includes all supplies (electrodes, tape, batteries, gel), Holter monitor, vest, diary, and a prepaid FedEx return label. Placement instructions will be provided in the package and an instructional video is on the website as well as in the confirmation email.

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