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Case Consultation Form
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Referring DVM Information:
Name of Hospital or Clinic
Veterinarian
Preferred Method of Contact:
Email
Phone
Email
Phone
Patient Information:
Primary Reason for Dental Consultation:
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 one business day of submission. VDCNC hours of operation are Monday-Thursday, so forms submitted on Thursday and Friday will be reviewed on the following Monday.
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