Consult Request Form

Please upload Behavioral and Medical Histories using the File Uploads tool below, THEN fill out the form below it and submit the form so that we can initiate the Consult process. We will get back with you as soon as possible with instructions on what to do before your Consult appointment.

BEFORE completing and submitting the Consult Request Form below, please Upload your Patient’s Medical History and the Completed Behavioral History Form using the File Uploads: feature below NOTE – Please name your pdf Files using the Patient’s and Client’s Surname so that we can file them correctly (e.g., “Fluffy Smith Behavior History.pdf”, “Spot Jones Medical History.pdf”)

File Uploads:

AFTER Uploading Behavior and Medical History Files, please conplete the Consult Request Form (below), then Check the “I’m not a robot” Box and then Click the Submit Button –

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Veterinarian's Name *

First

Last

Referring Veterinarian’s Name

Hospital Name *

Hospital Name

Email *

Breed Owner's Patient

Telephone Number *

Telephone Number

Patient Name *

Patient Name

Species *– Please Choose –CanineFeline

Choose Patient Species

Breed *

Please Enter Pet’s Breed

Owner's Name *

First

Last

Owner’s Name

Brief Case Summary *

Brief Case Summary – Reason for Consult – Major Medical Problems – Notes

Submit