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MaleMale NeuteredFemaleFemale Spayed
Approximate date of birth
Where you want dental records and discharge information sent
Reason for referring this pet
Previous treatment and response
List of major medical problems
Previous adverse response to medications
Any specific concerns regarding anesthesia sensitivity?
Please attach relevant medical and dental records. If able, lab work including CBC and chemistry should be done prior to referral.
*Accepted files: .pdf, .doc, .png, .jpg, .gif
Would you like our team to contact your client directly to schedule their consultation?YesNo
Please provide your preferred email address so that we can update you on your patient and any veterinary dentistry updates.
Where your pet is part of our Family