New Referral

New Referral Form

Client Info

Patient Info

Species: CanineFeline

Sex

Approximate date of birth

Hospital Info

Where you want dental records and discharge information sent

Patient Medical Info

Reason for referring this pet

Previous Treatment and Response

List of Major Medical Problems

Current Medications

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
File Size Limit: 6MB

Please have your client contact our office at 719-536-9949 to schedule their consultation and/or procedure.

Please leave this field empty.Please leave this field empty.

Call for Appointment

(719) 536-9949

Facebook Instagram

Employee Portal

Our Service area includes Colorado Springs, Castle Rock, Castle Pines, Southern Colorado, Colorado Western Slopes, Northern New Mexico, and Western Kansas.

Subscribe to our Newsletter

Veterinary Staff, sign-up and be informed about our upcoming veterinary dental CE courses!

Your title?DVMCVTPlease leave this field empty.Please leave this field empty.

Transparency in Coverage

The link below leads to the machine-readable files that are made available in response to the federal Transparency in Coverage Rule. The machine-readable files are formatted to allow researchers, regulators, and application developers to more easily access and analyze data.

UnitedHealthcare creates and publishes the Machine-Readable Files on behalf of Veterinary Group