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Dermatology Consult Form

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

This information will be routed to the Service that you request. We will do our best to respond as soon as possible. This will generally be within 48 hrs of submission. If you have not had a response within that time, please call the Service directly. Because consults are often addressed at the end of the day, please provide contact information for the late evening, if possible.

Veterinarian Contact Information

Fields marked with an * are required What is your preferred contact method?
Do we have your permission to ask your receptionist to interrupt you if you are with a client?

Owner Contact Information

Name of the owner

Information about the patient

Has this patient ever been seen by any service at NC State Veterinary Hospital?
Patient/Pet Name(Required)
MM slash DD slash YYYY