MRI & Scintigraphy Referral Form

MRI / Scintigraphy Referral Form

Below is the history form for your patient's MRI or Bone Scan. Please complete this form to the best of your knowledge and submit the form prior to your client's appointment. If you would like to speak to one of our doctors regarding this appointment or Jennifer Alvarez the hospital manager, please call 203.270.3600. You can also email Jennifer directly at jalvarez@fairfieldequine.com Thank you for scheduling your appointment with Fairfield Equine Associates!

General Information
For pickup and billing
Horse Information
Soundness History