5458 Buttonwood Dr, Madison, WI 53718
office@acesvetmed.com
608-333-0500

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Home
About Us
Services
Oncology
Client Resources
DVMs
Careers
Contact

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Forms

Oncology Veterinary Referral Form

Save time at your first appointment! Complete your required oncology veterinary referral form online before your visit.

Oncology Veterinary Referral Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit.

Referring Veterinary Information

Clinic Name *

Phone Number *

Veterinarian’s Name *

First

Last

Fax Number

Email Address *

Name of person submitting this form

Additional veterinary clinics the pet has seen in the past two years? If yes, please list.

Client Information

Client Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Alternate Phone

Email *

Alternate Email Address

Patient Information

Patient Name *

Species *

Dog
Cat

Breed *

Age *

Sex *

Male Intact
Female Intact
Male Neutered
Female Spayed

Color/Description *

DOB or Approximate Age *

Rabies Vaccine Current *

Yes
No

Weight (lbs) *

Temperament *

Referral to ACES Medical Oncology

Level of Urgency *

Routine Referral. Suspected or confirmed cancer with no rapidly progressing clinical signs. Examples: soft tissue sarcoma, stable mast cell tumor, anal sac mass, osteosarcoma, bladder mass, etc.
Urgent Referral (seen within 1-2 weeks). Suspected or confirmed cancer with progressive signs or clinical concern for rapid disease progression. Examples: Suspected/confirmed large cell lymphoma (clinically stable), rapidly growing mass.
Emergency Referral (seen within 1-2 days). Suspected or confirmed large cell lymphoma, acute leukemia, or hypercalcemia of malignancy with significant clinical decline.

For urgent/emergency concerns, please call us directly at 608-333-0500 in addition to completing this form. While we make every effort to accommodate urgent cases, availability is not guaranteed.

Appointment Schedule Preference: *

ACES will contact the client directly
Client will contact ACES to schedule

Reason for referral/primary complaint: *

Diagnostic workup performed: (Check all that apply) *

CBC
Chemistry
Urinalysis
Chest radiographs
Abdominal radiographs
Ultrasound
Cytology
Histopathology
Advanced imaging (CT, MRI)
Other

Other *

Relevant exam finding (eg. tumor location and size):

Relevant laboratory findings:

Relevant Imaging findings:

Recent medications/treatments and response:

Specific questions / Concerns to be addressed:

Please upload all medical records, lab results, diagnostic images, and pathology reports.

Click or drag a file to this area to upload.

Ready to visit ACES?

We proudly serve the pets of Madison, WI, and the surrounding areas, including Monona, Middleton, Verona, Sun Prairie, Fitchburg, Stoughton, Oregon, Lodi, Cottage Grove, Janesville, Beaver Dam, Reeseville, and Waunakee. We look forward to seeing you and your pet! To request an appointment, please call us!

Have a Question?

Please complete our online form and a member of our team will get back to you as quickly as possible (typically in 1-2 days). If you have an urgent or emergent matter, please call us at 608-333-0500.

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Contact Information

Phone: 608-333-0500

Email: office@acesvetmed.com



Location

5458 Buttonwood Dr,
Madison, WI 53718



Hours

Urgent Care
Monday–Sunday: 5pm – 2am
Open 7 days per week | 365 days per year

Oncology
Monday-Thursday: 8am – 5pm
(Closed on major holidays)

Name *

First

Last

Email *

Phone

How can we help you? *

Comment

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