If you have a patient that requires surgery, here is the process to follow:

Determine how urgent the procedure is.
If it needs to happen emergently, please contact an ER. If it is urgent (needs to happen in the next day or two), then please call our office to see if we can accommodate it in that time frame. If we can perform the procedure urgently, then we will direct you to fill out this form for more information, provide details for you to give to your client, and direct you on next steps.
If it is non-urgent, then please fill out this form that we will receive via email. We will contact you within 24-48 hours with next steps.

Notes

We will always discuss the procedure with clients in person before they drop their pet off with us.
We require a 100% deposit for the cost of the procedure prior to performing the procedure. We will provide an estimate to you and the client prior to the procedure.
Many patients will require post-op monitoring and may need to be transferred back to the primary vet in the morning or to an ER. Even though this may be more work for the client to have to transfer their pet several times, it can still be very helpful as we often charge less than an ER and many ERs are quite busy and may not be able to handle performing a surgery. Please make sure your clients are prepared for this though we will ultimately make sure they understand the plan once we speak with them.

Patient Information

Patient Name *

Breed *

Age *

Sex *

Neutered *

Yes
No

Client Information

Client Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Phone number where you can be contacted during your pets procedure

Email *

Referral Information

Referring DVM name *

Clinic Name *

Clinic Contact Phone *

Clinic Contact Email *

Surgery Needed (may select multiple if needed) *

Surgery specifics (i.e. requires right forelimb 3rd digit amputation due to injury, requires right‬ ‭ hind limb amputation due to osteosarcoma, etc): *

Tissues to be submitted:

Patient History

This information will help us get to know the patient, choose anesthesia, and to formulate history‬ for histopathology submission.‬
‭

Problems/concerns/reason for referral and any diagnoses:‬ ‭

Historical concerns

Current medications (please included doses and frequency):

Abnormal physical exam findings:‬ ‭

Labwork results:‬ ‭

Imaging results:

Differential diagnoses (if definitive diagnosis is unknown):

Known medication/sedation sensitivities:

Overflow Surgery and Endoscopy Referral Form