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Please use this form to submit a soft tissue & oncologic surgery referral request.

This service is for veterinarians only – clients seeking medical information should contact their regular veterinarian for assistance.

If you would like to make a referral to one of the VH Services and you do not need to talk to a VH clinician, you can use this form to submit the client and patient information. Please indicate on the form if you have told the client to call the VH, or if you would like us to call them. Please provide a summary of the history of the case so that we can be prepared to provide the patient with the appropriate care. Please send or fax supporting information. Please send radiographs or other images with the client or by submitting directly to us through eFilm (see instructions on main Information for Referring Veterinarians page).

 Recruiting Patients for Minimally Invasive Laparoscopic Procedures

Special packages are available for the following procedures: Ovariectomy (“spay”), gastropexy, cryptorchidectomy, or a combination of the above (aka ovariectomy AND gastropexy). Patients must be healthy. For additional details click here. Referral only.

If this is an EMERGENCY REFERRAL (i.e. needs to be seen within 24hrs), please call the appropriate service immediately after submitting the information below.

 

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Fields marked with an * are required

Veterinarian Contact Information

Owner Contact Information

Patient Information

Medical Record Data Accompanying Referral  (please fax 919-513.6715 or email NCStateSoftTissue@ncsu.edu)

NC State Estimate provided to owner (if any):