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Patient Referral- General
Thank you for being a part of our referring community! We try to accomodate all referrals as soon as possible. Please attach medical records and any relevant labwork and radiographs below or email them to info@grudavet.com.
Date of Referral
Date Format: MM slash DD slash YYYY
Referring DVM
Referring Practice
Phone
Email
Referral For:
Dr. Robert Gruda
Orthopedic
Soft Tissue surgery
Oncology
Dr. Natasha Stanke, DACVS-SA
Orthopedic
Soft tissue surgery
Other:
First available surgeon
Abdominal Ultrasound
Endoscopy
Internal medicine
If first available/other, please specify what surgery/procedure is needed:
Level of urgency
Emergency/same day
High priority
First Available
If this referral is emergency/same day/on the way PLEASE complete this form but call the clinic directly! We are not always able to accommodate same day emergency surgery cases.
Client Information:
Name
*
First
Last
Phone
*
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Email
*
Patient Information
Name
*
First
Species
*
Canine
Feline
Breed
*
Date of Birth
*
Date Format: MM slash DD slash YYYY
Sex
*
Intact Male
Neutered Male
Intact Female
Spayed Female
Weight (lbs):
*
Current Rabies Vaccine
Yes
No
Any known allergies/sensitivites:
*
History/Chief Complaint
*
Physical Findings
*
Tentative DX/Rule outs
*
Treatments/Medications
*
Laboratory last done (please attach):
Date Format: MM slash DD slash YYYY
Radiographs last done (please attach):
Date Format: MM slash DD slash YYYY
Files too large to attach? Please email them to info@grudavet.com
File
File
File
File
File
File
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About Us
Our Doctors
Our Team
Our App
Careers
Services
New Clients/New Pets
New Client Registration Form
New Pet Registration Form
Referrals
Referrals- Surgery/Endoscopy/General
Referrals- Echocardiogram
Contact Us
Resources
International Travel
Emergency
Online Store
Prescription Refill
facebook
