Refer a Patient

Dental Vet Asia is always pleased to accept referrals from primary care veterinarians. We accept all cases.

Do not hesitate to reach out if you have any questions.

Dental radiograph showing root canal treatment in a canine tooth

Radiographs & Bloodwork: Please send us a copy of the bloodwork and radiographs. You may email them to [email protected] or [email protected]. We request they be shared in JPEG format.

Referral Classification

How would you classify this referral?*

Routine

Urgent

Emergency

Today's Date*

Referring Clinic Information

Referring Clinic*

Referring Doctor*

Clinic Email

Clinic Phone Number

Owner's Information

Owner's First Name*

Owner's Last Name*

Email*

Phone Number*

District / Area

Patient's Information

Pet's Name*

Species*

Breed*

Birthday / Approximate Age*

Weight (kg)*

Sex*

Patient's Temperament

Clinical Information

Will an awake oral exam be possible without sedation?

Yes

Have dental radiographs/X-rays been taken?

Yes

NOTE: Please send us the dental radiographs/X-rays and bloodwork as soon as possible. We request they be shared in JPEG format. At minimum, please take photos and email them to [email protected] or [email protected]

Presenting Complaint and History*

Tentative Diagnosis

Current Medications

Has a CBC and chem panel been performed in the last 60 days?

Yes

Additional Diagnostics

Comments

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