MaleMale NeuteredFemaleFemale Spayed
Approximate date of birth
Where you want dental records and discharge information sent
Reason for referring this pet
Previous Treatment and Response
List of Major Medical Problems
Previous Adverse Response to Medications
Any specific concerns regarding anesthesia sensitivity?
Please attach relevant medical records and all dental records (dental chart, radiographs). If able, it is ideal for patients over the age of 10 years to have a T4 and thoracic radiographs done prior to referral. Any patients with cardiac concerns will be referred for a echocardiogram prior to any procedure.
*Accepted files: .pdf, .doc, .png, .jpg, .gif
File size limit is 6MB.
We will reach out to your client to schedule their consultation and/or procedure.