Equid Endocrinology & Obesity Outpatient ClinicRecheck Visit Consultation Form

Equid Endocrinology & Obesity Outpatient Clinic

Recheck Visit Consultation Form

This form is for referring veterinarians seeking a non-urgent consultation on patients seen at the Equid Endocrinology and Obesity Outpatient Clinic within the last year.

Eligibility

Has this patient been seen at the Equid Endocrinology & Obesity Outpatient Clinic at OSU within the last year?*

Yes

I don't know

Please call the Large Animal Hospital at 541-737-2858 for consultation.

Referring Veterinarian Information

Referring DVM*

Referring Clinic*

Email Address*

Please provide an email address for sending recommendations.

Phone Number*

Recommendations are sent by email, but we may call you if we have additional questions.

Client Information

Client Name*

Phone Number*

Patient Information

Patient Name*

Breed*

Case Information

Dr. Pacheco typically emails recommendations within 5 business days. If your patient has a time-sensitive need and you require a faster response, please call us at 541-737-2858 to request to speak to an available doctor.

Last Examination Performed by You

Date*

Laminitis Status*

If currently lame, degree

Body Condition Information*

Please provide information on the patient's weight loss progress, current weight (tape weight is acceptable), body condition score, & cresty neck score.

Evidence of Muscle Loss*

Haircoat Condition*

Vital Signs*

Other

Last Laboratory Tests

Please provide date and results for the following tests (if applicable). Note that we do not have access to Oregon Veterinary Diagnostic Lab (OVDL) results.

Insulin (indicate testing conditions such as baseline fed or fasted state, high or low dose OST), Leptin, ACTH, Triglycerides, any other tests

Additional Information

Current Diet*

Please provide details on amount of hay and any concentrate patient is receiving.

Current Medications*

Please include dose

Date & results of last feet radiographs

Date & Details of last hoof trim/shoeing

Additional Information

Provide any additional information, if desired.

Upload records/laboratory results/images from last visit

Photos showing patient's body condition, muscling, haircoat, and hooves can be helpful for more accurate consultation.

Drag and drop files here or

Please include links to view radiographs, if applicable

Request Details

What specific concerns do you have about the patient?*

Are there any specific recommendations you are seeking?*

Send me a copy of my responses

Privacy Notice|Report Abuse