Owner & Patient Information

☐Owner Information
– Full name
– Phone number
– Address
– Email address

☐Patient Information:
– Name
– Date of birth / Age
– Species and breed
– Sex (including desex status and date)
– Previous medical conditions and surgeries
– Known drug or food allergies
– Vaccination history (Rabies, Core/Annual, Bordetella, Leptospirosis)
– Parasite prevention history (Heartworm, flea, and tick prevention)

☐Cardiologist’s report

☐Chest radiographs (X-rays)

☐Echocardiographic videos (DICOM or AVI format), including:
– Right parasternal long-axis four-chamber view (with and without color Doppler)
– Right parasternal short-axis view at the papillary muscle level (M-mode)
– Right parasternal short-axis view at the mitral valve level
– Right parasternal short-axis view at the left atrium (LA) and aorta (Ao) level
– Left apical four-chamber view (with and without color Doppler)

E-Mail：jasmine.cardiology@gmail.com