| | 7522-7524 Clairemont Mesa Blvd.
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Imaging Service Request

Please complete the form below to refer a patient.
Fax: (858) 634-5435 • Alt Fax: (858) 256-7615

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RDVM Information

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Patient Information

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History

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Patient Referral Options

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Region of Interest

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Service Requested

Imaging Services

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Samples to be Collected

** Important: If Fast-Track Outpatient, please indicate client pricing for sampling & analysis below.

** If pricing is not indicated for sampling for Fast-Track clients, clients will be billed out directly by VICSD (on samples only).

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Veterinary Imaging Center

San Diego HQ

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7522-7524 Clairemont Mesa Blvd.
San Diego, CA 92111
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