Vet Referral Forms

Patient Referral

Please fill out a referral form for patients you are referring to us. We require bloodwork prior to the day of the procedure.

NAME*
First Last
CLINIC*
CLINIC OR VETERINARIAN EMAIL*
PATIENT NAME*
First
OWNER(S) NAME*
First Last
OWNER(S) PHONE NUMBER*
SPECIES*
PATIENT D.O.B.*
MM slash DD slash YYYY
PATIENT WEIGHT (Kilograms)*
DATE OF LAST WEIGHT*
MM slash DD slash YYYY
Patient Sex*
PRESENTING COMPLAINT*
ADDITIONAL ORAL EXAM FINDINGS*
DENTAL PROCEDURES OFFERED/DISCUSSED WITH CLIENT*
DUE DATE OF RABIES VACCINE*
MM slash DD slash YYYY
DATE OF MOST RECENT BLOODWORK*
MM slash DD slash YYYY
CONCURRENT RELEVANT MEDICAL CONDITIONS/ ADDITIONAL INFORMATION*
HAVE YOU CONTACTED US (EMAIL/PHONE/TEXT/PREVIOUS REFERRAL FORM) ABOUT THIS PET BEFORE?*
- YES
- NO
X-Ray or Photos
Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 128 MB, Max. files: 5.
(maximum of 5 jpg, gif, png images)
Bloodwork
Drop files here or

Accepted file types: pdf, Max. file size: 128 MB, Max. files: 5.
.pdf only

At Veterinary Dentistry and Oral Surgery of Ohio, we are a woman-owned practice, with the first woman Board Certified Veterinary Dentist in Ohio. A true leader in the veterinary dental space, our practice not only provides top care to our patients but also hosts doctors, technicians, and students from around the country for training and mentorship.

Get In Touch

Have questions or need to schedule an appointment?

p 614-467-9901
e schedule@ohiovetdentist.com