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Post-Operative Discharge Instructions
Referral Request
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Our Doctor
Frequently Asked Questions
Services
Resources
Surgical Consent Forms
Learning Center for Pet Owners
Post-Operative Discharge Instructions
Referral Request
Referral Request Form (Soft Tissue)
Home
Referral Request Form (Soft Tissue)
Referral Request Form (Soft Tissue)
Comments
This field is for validation purposes and should be left unchanged.
Referring Veterinarian
(Required)
Referring Hospital:
(Required)
Referring Email Address:
(Required)
Pet’s name:
(Required)
Client’s name:
(Required)
Pet’s DOB:
(Required)
MM slash DD slash YYYY
Breed
(Required)
Weight(kg):
(Required)
Sex:
(Required)
Male
Female
Altered
(Required)
Yes
No
Diagnosis:
(Required)
Location (if applicable):
(Required)
Side (if applicable):
RIGHT
RIGHT
Cytology/histopathology results?
Radiographs performed?
(Required)
YES
NO
Radiology review performed?
(Required)
YES
NO
Thoracic radiographs performed? (required for all trauma causes)
(Required)
YES
NO
Bloodwork performed? (required within 1-2 weeks for all surgeries)
(Required)
YES
NO
**Please email all cytology/histopath, bloodwork, radiographs, and radiology reports to
[email protected]
Please list all medications:
Any co-morbidities? (ex: endocrinopathies, renal/hepatic disease, cardiac disease)
Any other relevant information to patient/case?
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