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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:


Laparoscopy


First available surgeon


Abdominal Ultrasound


Endoscopy


Internal medicine


Exotics
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
Rabbit
Ferret
Reptile
Avian
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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Our Location
 
9 Rumble Rd

Santa Fe, NM, 87508

Contact Us
 
Phone: (505) 471-4400

Email: info@grudavet.com
 Emergency

Our Hours
 
M-F: 7:30am – 5:30pm

Sat: 8:00am – 5:00pm

Sun: Closed
 Online Store
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