Case Consultation Form

Referring DVM Information:

Name of Hospital or Clinic

Veterinarian

Preferred Method of Contact:

Email
Phone

Email

Phone

Patient Information:

Primary Reason for Dental Consultation:

Please provide your specific question or concern regarding the above consultation reason *

Pet Name

Breed

Sex

M
MN
F
FS

Age / Date of Birth

Dental Radiographs Available?

Yes
No

If yes, please upload.

Click or drag a file to this area to upload.

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.

Name

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