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Equine Bone Scan Referral Form

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).

Veterinarian Contact Information

Referral Status(Required)

Owner Contact Information


Information about the patient

MM slash DD slash YYYY
Reason for referral (select one)
Client Contact
Diagnostic data accompanying referral (please fax or send with client)

Medical History

1. Date of Last Vaccine

Owner Contact Information

Name of the owner(Required)

Information about the patient

Has this patient ever been seen by any service at NC State Veterinary Hospital?
Patient/Pet Name(Required)
Do you want the horse evaluated for lameness by our clinicians prior to scan?
Do you want a full body (~$1600-$1800) or partial body scan (~$1000-$1200)?
Do you want a soft tissue phase (additional ~$200)?
Is the horse currently in work?
Can the horse be lunged at NC State prior to the scan?
Is the horse currently being treated with any NSAIDs?
Which leg(s) is the horse lame on?
How would you grade the lameness (Using AAEP Scale)?
Has any blocking been performed?
Has any imaging been performed?
Does imaging need to be shared with an additional veterinarian?