Consult Requests

Consultation Policy

Our clinic is a specialty veterinary oncology clinic providing consultations for you through your primary veterinarian. Fill out our consultation form with as much detail as possible. You can email records to info@petonc.com if easier, or if you run out of room on our form. Consults requested by pet owners will not be completed. We look forward to working with you!

Consultation Request Form

Fields marked with an asterisk (*) are required.

Contact Information

Submitting Veterinarian *

Email *

Cell Phone

Practice Name *

Has your practice used our services before? *

Yes

Billing Contact Information

Billing Contact Name *

Email *

Practice Contact Information

Practice Address *

Country *

Country Name *

Address Line 1 *

Address Line 2

Province/Territory *

State *

State/Province/Region

City or Town *

Postal Code / Zip Code *

Practice Phone *

Services

Which service(s) would you like? *

Initial Consultation ($250)

Follow-Up Consultation ($55)

Client Information Sheets

Treatment type & protocol ($40)

Tumour type & protocol ($40)

Chemotherapy protocols ($40)

Drug handling & safety ($40)

Patient Information

Name *

Last Name *

Date of Birth *

Species *

Breed *

Coat Colour *

Sex *

Weight *

Disease History

Brief summary of history related to cancer

What medications and/or supplements is the patient currently receiving?

Any concurrent diseases and/or conditions?

Physical exam findings

What are the main questions that you and your client are hoping to address with this consult?

Any additional information?

Attachments

Please attach files below or email them to info@petonc.com. If emailing records, please double check that the most recent diagnostics & reports are included.

Upload File

Max file size 10MB.

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