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Consultation Request Form

To request a neurologic consultation for your patient please fill out the form below. Upload the patient's medical records, recent blood work and radiographs to the appropriate sections on this form. Send any additional information, or files which exceed 15MB, to

CBC & Chemistry completed
Upload Medical Records Here
Upload Additional Records Here
Chest rads performed?
Upload X-Ray Here
Upload Additional X-Ray Here

Thank you for requesting a consultation for your patient with the VSCAN!

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