PLEASE CALL FIRST in addition to sending records and client information.
Please also call the main number.
The Oncology team at The Pet Cancer Center thanks you for your referral. While we certainly value your time, we would greatly appreciate your taking a moment to complete this form. The information that you provide will give us a good start on providing your client and patient with our best service. Please feel free to fill out electronically or by hand and then email or fax back to CASE.
If you prefer, in lieu of filling this form out line by line, a case summary that includes the information below would also be welcomed. If you feel that a phone call or email might be an easier option, please feel free to contact us directly – our contact information is listed below.
(1) Please provide us with some information on your clinic:
(2) Please provide us with some information on the patient you are referring:
(3) Please provide us with some information on the patient’s cancer diagnosis:
(4) Please provide us with some information on the client:
(5) Please provide us with any additional pertinent patient or client information:
Please fax or email medical records and imaging to the contact information below. If you cannot send imaging, please provide the owner with images on a CD to bring to their appointment.
Thank you for your referral. A referral summary letter will be sent following your patient’s appointment.
Medical Oncologists: Dr. Brooke Fowler and Dr. Annie Galloway
Radiation Oncologist: Dr. Lyndsay Kubicek Staff
Surgical Oncologist: Dr. Cassandra Prpich
Depending on the amount and size of the files you select, the form could take several minutes to submit.
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Accepted file types: pdf, tif, jpg, Max. file size: 50 MB, Max. files: 10.
Drop files here or