Bay State Veterinary Emergency and Specialty Services

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Veterinarian Referral Form* This field is required.
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Emergency
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Surgery
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Outpatient Echocardiogram
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2
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3
Pet Information
Patient Name
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Spayed/Neutered?
4
Patient History* This field is required.Please send radiographs & copies of test results with client or email or fax copies with referral form
Diagnosis / Chief Complaint
Significant History / Treatments
Diagnostics Performed
5
Are radiographs being sent?
Yes
No
6
Tests pending (list)
7
Vaccination History
8
Current or Recent Medication or Therapy (include dosage/duration)
9
Referring Veterinarian Information
Referring Veterinarian Name
Clinic
Phone
Fax
Email
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Specialty Services

Internal Medicine
Gary Block, DVM, MS, DACVIM
Lauren Monhait, DVM
Caylie Voudren, MS, DVM, DACVIM (SAIM)
Sara Wilkes, DVM

Surgery
Lori Agulian, DVM, DACVS
M. Faulkner Besancon, DVM, DACVS
Lindsey Lavin, DVM

Medical Oncology
Amy Koterbay, BVMS, MS, DACVIM

Radiation Oncology
Kevin Ware, DVM, ACVR-RO

Critical Care
Justine Johnson, DVM, DACVECC

Dermatology
Carolyn Emery, DVM, DACVD

Emergency Clinicians
Danee Desrochers, DVM
Jenni Huelsman, DVM
Ann Klocke, VMD
Taylor LaFountain, DVM
Lindsey Miller, DVM
Meredith Nelson, DVM
Shelly Pancoast, DVM
Karolina Preisner, DVM
Robert Sander, DVM
Aubrey Sapala, DVM
Jessica Suarez, DVM
Jessica Van Loon, DVM
Shawni Wall, DVM
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Bay State Veterinary Emergency and Specialty Services 463 Swansea Mall Dr, Swansea, MA 02777
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