763-463-9800
[email protected]
8301 93rd Ave N.
Brooklyn Park, MN 55445

SURGICAL CONSULT REQUEST FORM


Fill the form below and email along with medical records, lab work, and radiographs to [email protected]. We will contact the client within 72 hours to set up a surgical consult appointment (unless marked urgent). Please call our Brooklyn Park location directly if needing a same day transfer to speak directly with a DVM.
Referring Hospital Information

Owner Information

Patient Information

Reason for Referral

Medical Records
Lab Results
Radiographs
File names should not contain any characters or spaces, please replace spaces with an underscore. (_)
One file only.
100 MB limit.
Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.