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Behavioral Medicine Referral Form

This service is for veterinarians only – clients seeking self-referral or additional information should contact their regular veterinarian for more information.

If you would like to refer a patient to the Behavioral Medicine Service and you do not need to speak to a clinician, you can use this form to submit the client and patient information. Please indicate on the form under “Client Contact” if you have asked the client to call the Behavioral Medicine Service, or if you would like us to call the client to schedule the consultation. Please provide a brief summary of the patient’s problem and send supporting documents (lab results, chart notes) via e-mail ( or fax (919-513-6905). After we see the client and patient in our office, we will send to you a detailed referral summary.

If you would like to speak to a clinician about a behavioral concern for a patient you are currently managing but have not referred, please email us (preferred) at or call 919-513-6999 and follow the prompts to reach the Behavioral Medicine Service phone service. Please be sure to leave your name, day and time when you can be reached, and a phone number you will be available by at this time.  We will make every effort to reply to your call within 2 business days.  Please note that the Behavioral Medicine Service is closed on Tuesdays.

Veterinarian Contact Information

Referal Status(Required)
Veterinarian to Contact(Required)

Owner Contact Information

Client Contact(Required)
Owner Name(Required)

Patient Information

Has this patient ever been seen by any service at NC State Veterinary Hospital?
Please specify LBs or KGs
Is the patient current on rabies vaccination?
Is the patient current on all other recommended vaccinations and preventative care?
Diagnostic data accompanying referral (please fax or send with client)