Get Radiograph Evaluation Application

Filling out the Radiograph Evaluation Application online is an important step in assessing your dog's hip health. This guide provides clear, step-by-step instructions to help you navigate each section of the application with ease.

Follow the steps to successfully complete your application.

1. Click ‘Get Form’ button to access the application and open it for filling.
2. Start by selecting your payment option from the available choices. You can choose between a $35 evaluation fee or a $40 priority evaluation fee, which offers a quicker processing time.
3. Fill in the required fields under 'Radiograph Information'. This includes your member number, distractor number, and member name. Specify the date of the radiograph, the patient's weight, and any clinical signs that are observed.
4. Indicate the severity of any clinical signs by selecting the appropriate checkboxes (yes, no, not evaluated, mild, moderate, severe) and provide details about drugs used for restraint and the duration in months.
5. Next, provide accurate client information in the section designated for the dog owner. Make sure to mark whether your address has changed since the last evaluation.
6. Complete the dog information section thoroughly. Indicate if the dog has had hip surgery, the registered name, breed, and other identification details. Make sure to note if this dog has had a PennHIP radiograph before.
7. Detail the dog's birth date, whether they are neutered or spayed, and provide the DNA profile number, if available. Indicate the OFA rating if known, along with other requisite identification numbers.
8. Read the certification statement carefully before signing. Ensure that you understand the implications of submitting this information and that all the details regarding your dog are accurate.
9. Once you have completed all sections, review your application for accuracy. You can then save your changes, download a copy, and print it for your records.
10. Finally, submit the filled application page along with the required radiographs to the specified PennHIP Analysis Center address.

Complete your Radiograph Evaluation Application online today to ensure the best care for your dog.