Complimentary Case Review Form

Dr. Erica Tolar DVM, DACVO

500 N. English Station Road Suite 111

Louisville, KY 40223

502-242-5504 (p) 502-677-0015 (f)

bluegrassvetvision@gmail.com
Complimentary Case Review Form
Primary Care Veterinarian
Clinic Name
Email
example@example.com
Best Phone Number to Contact You Regarding This Case
Owner's Name
Best Contact Phone for the Owner
Patient's Name
Species
Breed
Weight
Sex/Altered Status

Male Female Castrated Spayed
Date of Birth

Month Day Year
Date
Color
Temperament
Eye Involved
Duration of Signs
Schirmer tear test results (OD/OS)
Fluorescein stain results (OD/OS)
Intraocular pressure results (OD/OS)
History and underlying comorbitities
Clinical Signs/Ophthalmic Findings/Diagnostic Tests
Current Treatment/Medications
If lab work has been performed in the last three months please attach copies
Should be Empty: