VTH Small Animal Consultation & Referral Request Form

VTH Small Animal Consultation & Referral Request Form

Thank you for contacting the OSU Lois Bates Acheson Veterinary Teaching Hospital. To refer a patient or request a consultation with one of our doctors, please complete the fields below.

Referring DVM*

Referring Clinic

Clinic Phone Number*

Clinic Email Address

Request Type*

(May select more than one)

Consultation - Would like to speak with a doctor about your patient

Referral - Would like an appointment for your patient

Service*

Select

Please select any services that may be appropriate for this patient

Select

Consultation Request

One of our doctors will contact you within 2 business days to consult on your patient. If your request is urgent, please call us at 541-737-4812.

Scheduling Preference?*

OSU to contact client to schedule

Client will call to schedule

Urgency of Request*

Emergent: Non-stable patient. Please call 541-737-4812 immediately after submitting this form.

Urgent: Will be triaged by requested VTH service for appointment

Non-Urgent: Can be scheduled for next available appointment

Emergent

Urgent

Non-Urgent

Patient Complaint/Differential Diagnosis:*

A brief description of the reason for referral or consultation request

Orthopedic Exam Findings:*

Neurologic Exam Findings:*

Patient Name:*

Patient Species:*

Canine

Feline

Other

Client Name:*

Client Phone Number:*

Additional Information

Provide any additional information, if desired

Records*

Records are required as part of the referral process. Please include any pertinent medical notes, lab results, imaging reports, etc. Email imaging to sa.reception@oregonstate.edu (DICOM strongly preferred). Please be aware that we do not have access to lab submitted to the Oregon Veterinary Diagnostic Lab (OVDL).

Drag and drop files here or

Contact Information

Oregon State University

Lois Bates Acheson Small Animal Veterinary Teaching Hospital

700 SW 30th Street

Corvallis, OR 97331

541-737-4812

https://vetmed.oregonstate.edu/hospital

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