Practice details
Owner details
Patient details
Outpatient details: CT
Brief relevant clinical history, including presenting signs and provisional diagnosis:
Questions to be answered by the report:

* When scanning a single joint, both left and right sides will be scanned for comparison, only one area will be charged
** When scanning multiple joints on one limb (ex: whole limb), two areas will be charged

* We generally use contrast agent on all scans except for elbow scans
* Recent blood test results (haematology and biochemistry) MUST be included if contrast is required.

- Has no known cardiac or renal problems
- Does not have any metal fragments in any body part
- Has not had any surgical intervention involving placement of metal implants, plates, or clips - Does not have any type of electronic, mechanical, or magnetic implant (excluding microchip)
- Has not had any surgery in the past two months
- Is not pregnant

Patient history / Recent blood tests
Please attach patient history and recent blood tests (we need both). Choose a file and then upload it. Repeat process for each file.
Files must be less than 8 MB.
Allowed file types: gif jpg jpeg png txt pdf doc docx.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.