TEST PAGE TESTING 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*CanineFelineWeight (kg)Breed*Age*Sex*Spayed FemaleFemaleNeutered MaleMaleReferral InformationType*Anesthesia & Pain ManagementCardiologyDermatologyDiagnostic ImagingEmergency & Critical CareInternal MedicineI-131Medical & Radiation OncologyNeurology / NeurosurgeryRehabilitation & Integrative MedicineSurgeryInterdepartmental referral OK if necessary*YesNoMedical 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.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: 250 GB Files Folders
