Oncology Service Referral Form If you are a veterinarian looking to refer a patient to Veterinary Medical Center of Central New York, please complete the Oncology Service Referral form below, and contact us at (315) 446-7933 if you have any questions. Oncology Service Referral Form Referring Hospital * Phone * Referring Veterinarian Practice Email * Pet Owner Name * Pet Owner Name First First Last Last Email * Pet Owner Phone Number * Pet Name * Age/DOB Weight Color Species * Breed Sex * MFM/CF/S Referral Summary pertaining to current problem/diagnosis.*Please include a summary of past medical / surgical problems and information about any allergies or adverse medication reactions the patient has had in the past. (Note: Dr. Rassnick does not need the entire medical record) * Has this pet been evaluated for this problem at another veterinary hospital? - Please Select -YesNoN/A If yes, where? This pet has... Bloodwork and test results/reports Urine test results/reports Radiology Report Ultrasound Report CT Report MRI Report Cytology Report Histopathology Report Please upload any results/reports for items selected above, as well as any additional files you may have Drop a file here or click to upload Choose File Maximum file size: 52.43MB Please note that client appointments will not be scheduled until all required referral documents, including relevant diagnostic results, have been received in full. Thank you for this referral and your ongoing support! Please feel free to contact us at any time. Captcha Submit If you are human, leave this field blank.
