New Teleradiology Client Form

Welcome to Clearview Veterinary Imaging’s teleradiology service. This form is designed for veterinary practices interested in partnering with our board-certified radiologist for remote imaging interpretation.

Please complete the form to get started. Once submitted, our team will reach out to provide setup instructions, discuss service options, and ensure your clinic has seamless access to timely, clinically relevant radiology reports for your patients.

Tuxedo cat with our board-certified radiologist

Submit a Request

New Telerad Client Form
Your Name
Your Name
First
Last
What is your role at your practice?
What is your practice's address?
What is your practice's address?
City
State/Province
Zip/Postal
Which imaging modalities are you looking at tele-specialty services for? (check all that apply)
I, as a representative of my practice, understand that as a veterinary practice and for any associated practitioners affiliated with said clinic, requesting consultation with a telespecialist, said practice will be responsible for all charges accrued by provided consultation services. Invoices will be generated at the end of every month and due in 30 days of receipt data.