Consult Request

Consult Request

Veterinarian to contact *

Clinic/Hospital *

Email *

Preferred way to contact you *

Email

Phone

Phone number *

Best time to call

---

Consult Service

Select a service *

Anesthesia Cardiology Dentistry & Oral Surgery Dermatology (established patients only) General Surgery Medical Oncology Morrie Waud Large Animal Hospital Neurology Ophthalmology Orthopedic Surgery Primary Care Radiation Oncology Small Animal ER Small Animal Internal Medicine Special Species

---

Patient Information

Has this patient ever been seen at UWVC? *

Yes

No

Not sure

Owner name *

Patient/Pet name *

Species *

Breed *

Date of birth or age *

Weight

Sex *

M

MN

F

FS

---

Patient History

Pertinent medical summary (please include duration of the problem, abnormal exam findings, abnormal finding on imaging, diagnostic results, treatment, medications with dosages, and your working diagnosis if applicable) *

Specific questions to be addressed

Do have any files to attach? * No Yes

reCAPTCHA

If you are human, leave this field blank.

Next