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Soft Tissue & Oncologic Surgery Referral Form

This service is for veterinarians only – clients seeking medical information should contact their regular veterinarian for assistance.

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 send or fax supporting information. Please send radiographs or other images with the client or by submitting directly to us through eFilm (see instructions on main Information for Referring Veterinarians page).

We are typically booked 3 months out (6 months for elective laparoscopic cases), but will make every attempt to schedule more urgent cases as soon as possible. Please be advised we may not be able to accommodate all requests.

Recruiting Patients

Special packages are available for the following procedures: Ovariectomy (“spay”), gastropexy, cryptorchidectomy, or a combination of the above (aka ovariectomy AND gastropexy). Patients must be healthy.

Veterinarian Contact Information

Referral Status(Required)
Veterinarian to Contact(Required)

Owner Contact Information

Client Contact(Required)
Name of the owner(Required)
Address

Patient Information

Has this patient ever been seen by any service at NC State Veterinary Hospital?
Reason for referral (select one)

Medical Record Data Accompanying Referral (please fax 919-513.6715 or email NCStateSoftTissue@ncsu.edu)

Medical Records
Diagnostic Data Already Performed (check if available, please attach results)
Imaging (please check if available)

NC State Estimate provided to owner (if any):

Drop files here or
Max. file size: 195 MB.