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Pet Emergency Spokane - Clinic Referral
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5
Questions
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1
Is this an Internal Medicine or Oncology request?
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Internal Medicine
Oncology
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2
Clinic's name
Doctor's name
Clinic Phone Number
Fax
Email
Client name
Client phone number
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3
Patients name
Patient breed
Age
Sex
Please Select
k9
feline
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Please Select
k9
feline
k9 or feline
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Spayed
Neutered
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Please Select
Spayed
Neutered
Spayed or Neutered
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4
Attach any applicable records
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: 10.6MB
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5
Dr. Summary
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