Qalibra Outpatient Request Form

To help us optimize the information we can obtain for you please include all pertinent information including but not limited to lameness duration, palpation findings, grade/characteristics of lameness, blocking pattern, if switches limbs following blocking, prior imaging and findings, etc.

Please share the details of your concern regarding your horse and why you are requesting a CT scan. Explain your goals for your visit, including if you would like to have a consultation or further evaluations, diagnostics, and/or treatments done while you are here for your appointment.