Temporary Page Referring Veterinarian's InformationFirst Name* Last Name* Clinic* Email* Would you like to receive VSC's Referring Veterinarian Newsletter? Yes, please. No, thank you. Personal Email* Client's InformationFirst Name* Last Name* Phone*Patient's InformationPatient's Name* Species* Canine Feline Weight (kg) Breed* Age* Sex*Spayed FemaleFemaleNeutered MaleMaleReferral InformationType*For outpatient ultrasounds, please use our Ultrasound-only Referral Form. Anesthesia & Pain Management Cardiology Dermatology Emergency & Critical Care Internal Medicine I-131 Medical & Radiation Oncology Neurology Rehabilitation & Integrative Medicine Surgery Interdepartmental referral OK if necessary* Yes No Medical InformationAny size files can also be uploaded below.Primary Problem(s)*Pertinent Medical History*Diagnostic Tests Performed/Results*Type NONE if applicable.Current Medication*Type NONE if applicable.Previous surgical and/or other procedure(s) and date(s)Upload Any Size Files (records, labs, radiographs, ultrasounds, MRIs, CTs, etc.)Please upload a one-year history, current blood work, imaging, and any other relevant information. Clicking on "select a folder", will only allow the upload of an entire folder and not individual files. IF RECORDS ARE NOT UPLOADED OR RECEIVED WITHIN THE NEXT 48 HOURS, IT WILL RESULT IN CANCELLATION OR RESCHEDULING OF THE APPOINTMENT.To view this content, you need to have JavaScript enabled in your browser.To do so, please follow these instructions. Add your files Or select a folder Maximum size: 1 GB Files Folders Download IF CLICKING SUBMIT BUTTON BELOW DOES NOT DISPLAY SUBMISSION SUCCESSFUL, PLEASE SCROLL UP, CORRECT ANY FIELDS HIGHLIGHTED IN RED, AND TRY AGAIN.CommentsThis field is for validation purposes and should be left unchanged. Δ
