Cardiology History Referral Form

University of Florida Veterinary Cardiology History Form

Please use this form after patient has a confirmed appointment with Cardiology Service.
  • new murmur, radiographic cardiomegaly,collapse or syncope, cough.
  • It is useful if you provide a few brief details or case summary regarding the primary reason for referral, including the results of an relevant diagnostic tests. Current blood test results, radiographs, ECG, BP and any previous echocardiogram or Holter reports should accompany the referral if possible to facilitate a cost-effective work-up.
  • Accepted file types: jpg, gif, png, pdf.
  • e.g. patient has degenerative joint disease, is hypothyroid, has asthma, was treated for HW disease 3 years ago, etc.
  • Note: include therapeutic diets, supplements and medications used intermittently such as NSAIDs
  • e.g. anesthetic agents, antibiotics, steroids, furosemide, analgesics etc