Small Animal Internal Medicine

This form is to submit information to the small animal internal medicine service ONLY for consultation purposes. If you are a veterinarian needing to refer a patient to the Bailey Small Animal Teaching Hospital, you will need to complete a referral request here. If this is an emergency, call (334) 844-4690. Consults will be answered in approximately 2 business days Monday-Friday.

Internal Medicine Consultation Form

Veterinarian Info

Veterinarian Name(Required)

First Last

Veterinarian Email(Required)

Clinic Name(Required)

Clinic Phone(Required)

Patient Info

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)

Consultation Info

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