CONSULT ONLY: New Patient Consultation

New Patient Consultation - Consult Only
Veterinary Oncology Partners offers customized chemotherapy single-dose delivery and step-by-step guidance through chemotherapy protocols. We are doing our best to continue expanding, but right now chemotherapy is offered in select states (see below).
Please fill out the below fields and upload all relevant documents. A specialist will review the history, imaging, reports, and make recommendations. You will receive a consultation report sent to the email provided below within 24hrs (1 business day). Your report may suggest additional diagnostics for staging purposes; it will also provide treatment options, expectations and prognosis.
Date

MonthDayYear
Today's Date
Client Name

First NameLast Name
Client's Phone Number
Format: (000) 000-0000.
Client's Email
example@example.com
Client's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Patient Name
Age (Years)
(For example: 1.5 yrs)
Sex
Species
Breed of Dog
Breed of Cat
Breed
Weight (in pounds)
Veterinarian Name

First NameLast Name
Veterinarian Email (The final report will be sent here. We CANNOT send directly to the pet owner)
example@example.com
Veterinarian Phone Number (cell phone or office number)
Format: (000) 000-0000.
Hospital / Practice Name
Veterinary Hospital / Practice Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Has this patient been definitively diagnosed with cancer based on histology or cytology?
Diagnosis
Date of Diagnosis

MonthDayYear
Date of original cancer diagnosis or start of related clinical signs
Please upload any Cytology / Histology reports here.

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You have selected "Other", please explain below:
General Assessment
Please choose all that apply. You can give additional details as indicated if you select the "Other option:

Other
Recent labwork (within the last month)?
Date of most recent lab work

MonthDayYear
Date
Please upload most recent labwork (CBC, Chemistry).

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Has this patient had any imaging (radiographs, ultrasound, CT)?
Please attach all radiographs, ultrasound images, and all reports for imaging below (JPEG/JPG/PNG/GIF images accepted):

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Please attach all the medical notes / SOAPs below:

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Doctor Case Summary / History of recent events
ALL Current Medications (including dose and frequency)
(Ex: Carprofen 50mg PO q 24h)
Has this patient received ANY steroids within the last month?
Please list the steroid given and dosage, including tapering schedule if indicated.
(Ex: Prednisone 10mg PO q 12h)
What was the Date that Steroids were last given?

MonthDayYear
**Choose Today's date if patient still on steroids**
Concurrent and/or Previous Diagnoses
Write "None" if nothing to add.
Please let us know if you have any specific concerns or questions!
Authorizing Veterinarian Name

Invoicing Summary (The following amount will be charged to your credit card below upon submitting this form)

Initial Consultation

$199.00

Subtotal

Tax

Total

Debit or Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

Can I order chemotherapy for my patient?

If you wish to become a VOP partner and be able to order customized chemotherapy for your patients, you must first complete some simple training and a short onboarding process (< 30 mins of dedicated time). Once completed you will have the option to order individually-dosed, customized chemotherapy for your patients which is sent to you in a closed delivery system to be given to the patient in your practice setting.

The VOP system allows you to be in complete OSHA compliance without the need for hoods or special rooms, and our specialists guide you, step-by-step, along the way! This option is currently available in the following states:

Kentucky

Illinois

Indiana

Florida

Colorado

New Jersey

For more information, please CLICK HERE to be redirected to an information form, and a VOP representative will reach out to you directly!
Should be Empty:

New Patient Consultation - Consult Only

Invoicing Summary (The following amount will be charged to your credit card below upon submitting this form)*

Invoicing Summary (The following amount will be charged to your credit card below upon submitting this form)