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Diagnostic Imaging Service

Royal (Dick) School of Veterinary Studies

The University of Edinburgh

Easter Bush Campus

Midlothian

EH25 9RG

Telephone 0131 650 7650

RDSVS Radiology Consult Request FoRm

Requesting VETERINARIAN & PRACTICE:

Requesting Veterinarian Name:

Response Email:

Response Phone:

Praxis Name & Address:

OWNER / ANIMAL NAME:

Signalment:

Brief history:

REASON FOR CONSULT REQUEST:

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