Name: Lakewood Animal Hospital
Address: 1151 Lakewood Court North, Regina, SK, S4X 3S3, CA
Telephone: (306) 545-6487
Price range: $$

CLIENT INFORMATION
Name
First Last
Phone
Email
PATIENT INFORMATION
Patient Name
Species
Breed
Age
Sex
REFERRING CLINIC INFORMATION
Referring Clinic
Phone
Fax
Email
INFORMATION
Do you understand that the pet will be shaved?*
- Yes
Do you understand LAH will not discuss results? This is the responsibility of the referring DVM. A report will be sent to the referring clinic within 24 hours.*
- Yes
Do you understand all patients are sedated for full abdominal ultrasounds.*
- Yes
Is there any contraindications for this patient's sedation?*
- Yes
- No
Case History:
Diagnosis/Treatment Recommendations:
Medical records have been sent?*
- Yes
- No
Email medical records and diagnostics to lakewoodanimal@sasktel.net
Fax medical records to 306-545-1374
Lakewood Animal Hospital 1151 Lakewood Court North Regina, Saskatchewan
Phone: (306) 545-6487 Fax: (306) 545-1374

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CLIENT INFORMATION

PATIENT INFORMATION