Surgical Consultation Request

Provide Details to Schedule Your Consult

Please provide the following information to request a surgical consultation from our veterinarian surgical specialists:

Date of request: *

Veterinary clinic name:

Veterinarian name: *

Phone number

Email address *

Patient name: *

Species: *

Breed: *

Age: *

Sex:

Basic description of medical issue/condition:

Diagnostics performed (bloodwork, radiographs, etc.): *

Type of surgical procedure being requested: *

Ideal timing for consultation: *

Does the patient need to be seen on an emergency basis?: *

Yes

Please provide any other relevant history or details about the case: *

We’d like to send you text messages for appointment reminders, confirmations, surgery information, and important updates about your pet. Do we have your permission to contact you by SMS?

Please select at least one option.

Yes

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Midwest Veterinarian Surgical Services