How Can We Help?
How urgently are you looking for help?
*
URGENT, patient is critical. (available for current SCVIM patients seen within a year ONLY)
within 24 hours (available for current SCVIM patients ONLY)
up to 72 hours
Other
Your Clinic Name
*
Your Name (as Doctor to Contact)
*
Phone Numbers, Dates and Times for Contact
*
Email Address:
Has the patient been cared for by SCVIM already (so we can pull our record)?
*
Yes
No
CLIENT NAMES and PATIENT NAME :
*
Is your question about the same condition or a new concern?
*
Same condition and I would wait up to 3 days to speak to their attending specialist
Same condition and I really hope to speak to someone today, even if this is a different specialist
New condition
Patient Breed
*
*
Female
Male
*
Spayed
Intact
Neutered
Intact
Age (years, approximate age is okay)
*
Would you like to consult with an internist or oncologist?
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INTERNIST
ONCOLOGIST
Do you have confirmed CYTOLOGY or HISTOPATHOLOGY?
*
Yes
No
What is the diagnosis?
*
Anal Sac Adenocarcinoma
Hemangiosarcoma
Hyperparthyroidism
Lymphoma
Mast Cell Tumor
Osteosarcoma
Sarcoma (limb, external)
Sarcoma (internal)
Other
What is the body system of primary concern?
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Liver and / or gall bladder
GI tract and / or pancreas
Endocrine
Kidney
Lower Urinary Tract
Heart
Upper Airway
Lower Respiratory
Other
SCVIM no longer provides evaluation or care for cardiac disease and pulmonary hypertension. We recommend contacting a cardiologist.
Stop this form and I will contact a cardiologist.
I still request SCVIM consult.
Short clinical highlights, including patient signalment if not a SCVIM patient:
What questions do you have?
You may upload medical records here or email to: frontdesk@imvets.com
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If you are asking for a radiograph review, what studies will you be sending? We no longer provide advice on primary heart cases.
Chest
Abdomen
Other
Paste link to radiograph study here, or email images or to frontdesk@imvets.com .
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