Veterinarian Referral Form
For veterinarians referring their client to Dr. Kyla Boas for a behavior consultation, please fill out the form below. Medical records can be emailed to behavior@cassvetservice.com. The Behavior Program will contact your client directly to schedule. After your client's initial appointment and any future recheck appointments, we will send a copy of the discharge discussion to your clinic. Please note that it may take 48-72 hours for our staff to contact the owner to schedule an appointment.
Referring clinic's name:
Referring veterinarian's name:
Phone number of referring veterinary clinic:
Please enter a valid phone number.
Email address of referring veterinary clinic:
example@example.com
Name of client:
Client's phone number:
Please enter a valid phone number.
Client's email address:
example@example.com
Name of patient:
Patient species:
Dog
Cat
Other
Patient age:
Patient breed:
Patient sex:
Intact female
Spayed female
Intact male
Neutered male
Chief complaint and/or diagnosis:
History and physical exam findings:
Treatments (previous and current):
For medications, please list names, doses, and frequency.
Current medications (behavior and non-behavior):
Please list names, doses, and frequency.
Additional requests or comments:
Submit
Should be Empty: