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Surgical Referral Form for Veterinarians

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    Surgical Referral Form for Veterinarians

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    Please Select
    • Please Select
    • Male
    • Female
    • Male Neutered
    • Female Spayed
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    Please Select
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    • Always
    • Never
    • Client Preference
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    Radiographs Taken:    If Yes, then                   

    Laboratory Work Done:      If Yes, then       

    Ultrasound Performed:       

    Ultrasound Performed by:       

    4DX Done:       

    Results:       

    Patients need to be UTD on Rabies
    Expiration of UTD Rabies vaccine:    Pick a Date                

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