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 * Name * Name First First Last Last Email * Primary Phone * 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 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.
