Small Animal Internal Medicine Consultation Form

INTERNAL MEDICINE CONSULTATIONS ONLY.

Consults will be answered in approximately 2 business days Monday-Friday.

Veterinarian Name(Required)

First Last

Veterinarian Email(Required)

Clinic Name(Required)

Clinic Phone(Required)

Owner's Name(Required)

First Last

Patient Name(Required)

Species(Required)

Dog

Cat

Sex(Required)

Male (intact)

Male (neutered)

Female (intact)

Female (spayed)

Breed(Required)

Age(Required)

Presenting Complaint(Required)

History(Required)

Consult Goals(Required)

What are the main questions and/or concerns that you would like us to address?

Physical Exam Findings(Required)

Lab Work

Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 24 MB, Max. files: 6.

Radiology Findings

Radiology Files and/or Images

Drop files here or

Accepted file types: jpg, gif, png, pdf), Max. file size: 24 MB, Max. files: 6.

Treatments Given

Include treatments and treatment details (dosage, route, duration) and any clinical response.

Potential Plan