| Check the Tests Ordered
in the column to the left. |
Cost | |
| Thyroid Profile D8T (T3, T4, Free T3, Free T4, T3 auto antibodies and T4 auto antibodies.) Please enter number of hours between giving thyroid medication and blood draw:_______ | $65.00 | |
| Add on TGAA for genetic screening | $17.00 | |
| Add on TSH | $19.00 | |
| Phenobarbital Profile #5624. Number of hours between giving medication and blood draw:________ | $24.00 | |
| Potassium Bromide Profile #16120 | $34.00 | |
| Profile #7200 includes CBC, Differential, Superchem (includes liver enzymes) and D8T thyroid. Number of hours between thyroid medication and blood draw:_________ | $54.50 | |
| SuperChem Profile (includes liver enzymes) | $29.00 | |
| Other tests: | $ | |
| Subtotal of all Tests
|
$ | |
| ***IMPORTANT***
ADD PROCESSING FEE |
$10.00 | |
| Grand Total |
$ | |
|
Please make check out to HEMOPET.
CALL HEMOPET TO VERIFY PRICES. Dr. Dodds, Hemopet
|
| owners name: | phone: |
| address: | best time to call: |
| City, State, Zip: | Fax |
| Vet Hospital: | Vet's Phone: |
| Vet's Name: | Vet's Fax: |
| Vet's Address: | Pet's name: |
| City, State, Zip: | Pet's date of birth |
| other medical problems: | Breed: |
| Sex (circle one): Male Neutered Female Spayed | Pet's weight: |
| Pet's current medication: | frequency of seizure: |
