Referral Request Updated 2024 SCVIM

  • Your Guide to Advanced Care for Your Patients

  • Are you requesting an urgent consultation for this patient?*
  • What is the nature of the emergency?*
  • What type of surgical emergency do you suspect?*
  • Do you strongly suspect or have confirmed it is CANCER?*
  • Do you have confirmed CYTOLOGY or HISTOPATHOLOGY?*
  • Is it LYMPHOMA?*
  • What is the diagnosis?*
  • For LYMPHOMA, we hold specific appointments with an ONCOLOGIST to allow treatment to start as quickly as possible. Do you accept this recommendation?*
  • What clinical concerns do you have?*
  • We recommend an appointment with an ONCOLOGIST. Do you accept this recommendation?*
  • What is the body system of primary concern?*
  • What endocrine disease is suspected?*
  • What form of upper airway disease is suspected?*
  • For nasal disease or undefined disease, we recommend a consultation with an INTERNIST.*
  • For Primary Hyperparathyroidism, we recommend consultation with an INTERNIST. Do you accept this recommendation?*
  • We recommend a consultation with an INTERNIST.*

  • If you have requested an urgent appointment with our support veterinarian, we will let you know soon if we can accommodate this request. If the patient is unstable, please seek care at an emergency clinic. Please honor that we are by appointment only and do not accept walk-ins.

  • If we are unable to accommodate this appointment within 3 business days, what would you like to do?*
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  • Do you have questions you would like answered prior to the consultation?
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