Please take note that an appointment has to be secured before submitting this request form. Thank you. Referring Veterinary Hospital : *Referring Veterinarian : *Client Surname: *Patient Name : *Patient ID : *Age : *Birthday (dd /mm / yyyy) : Sex : *Male EntireMale NeuteredFemale EntireFemale SpayedSpecies : DogCatOtherPlease Specify if Other Species : Breed : Body Weight (kg) : *History : Primary Ddx / Clinical Question : CystocentesisFNABiopsy (Note: Patient was tested for coagulopathy)FNA Site(s) : Biopsy Site(s) : CommentSubmit