Case Consultation Form

Referring DVM Information:

Name of Hospital or Clinic

Veterinarian

Preferred Method of Contact:

Email
Phone

Phone

Patient Information:

Primary Reason for Dental Consultation:

Please provide your specific question or concern regarding the above consultation reason; be as detailed as possible so we may better assist you *

Pet Name

Breed

Sex

Age / Date of Birth

Dental Radiographs Available?

Patient Records

Click or drag files to this area to upload. You can upload up to 10 files.

Consultation requests are reviewed within two to three business days of submission. VDCNC hours of operation are Monday-Thursday, so forms submitted on Thursday and Friday will be reviewed the following week.

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