Orthopedics Referral Form

If you would like to make a referral to one of the VH Services and you do not need to talk to a VH clinician, you can use this form to submit the client and patient information. Please indicate on the form if you have told the client to call the VH, or if you would like us to call them.

Please provide a summary of the history of the case so that we can be prepared to provide the patient with the appropriate care. Please email supporting information to the Orthopedics Service email – ncstateorthopedics@ncsu.edu. You may also fax the form to 919-513-6715.

Please send radiographs either by submitting directly through the online submission — instructions are here, sending a link to the Orthopedics Service email, or by attaching good quality jpeg images directly to an email. If you upload images directly, please let us know that this has been done. If these options are not possible, please send any images on a CD with the client. Continued limitations with the Veterinary Hospital limits our ability to perform elective surgeries.

At this time, we are currently booking appointments into summer. We will triage referrals as best we can for more emergent cases, but please be advised we are not able to accommodate all requests.