Oncology Referral Form *Required Referring Veterinarian Information How would you prefer to be contacted about this case?PhoneFaxEmail Client Information Patient Information SPECIES: Avian/ExoticCatDogOther SEX: FFSMMNUnknown Medical History Past relevant history Diagnosis Medical treatments and current medications/supplements Please list any tests performed and any radiographs that have been attached Pending Tests Please attach any documents or images related to this case below. You may also fax any information to 203-867-5195 Δ