Phone: 802-878-2022
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Benefits and Perks
Veterinary Training Programs
Our Services
Behavior
Diagnostic Imaging
Internal Medicine
Oncology
Ophthalmology
Surgery
Urgent Pet Care
For Your Pet
Client Registration Form
Appointments + Urgent Care
Client Portal
When Your Pet is a Patient
Clinical Studies
Pet Insurance
Online Store
Grief Resources
For Veterinary Teams
Our Referral Process
Referral Forms and Portal
At a Glance
Ethos Materials for Clinics
Continuing Education
VetBloom CE
Clinical Studies
About Us
Our Hospital
Our Team
Why Ethos
Ethos Discovery
Contact Us
Blogs & Videos
Our Blogs
PAWEDcasts
We’re Hiring!
Apply Today
Benefits and Perks
Veterinary Training Programs
Phone: 802-878-2022
802-878-2022     |     158 Hurricane Lane, Williston, VT 05495
Referral Form
Referring Veterinarian Information
Referring Doctor Name
*
Referring Clinic
*
Phone
*
Fax
Email
Preferred Method of Contact
*
Phone
Fax
Email
Which Department are you referring to?
*
Behavior
Cardiology
Dermatology
Internal Medicine
Oncology
Ophthalmology
Radiology
Ultrasound
Surgery
Would you like us to call this client to schedule an appointment?
*
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Type of Appointment Needed
Urgent
Follow up Consult
New Consult appointment
Client Information
Client First Name
*
Client Last Name
*
Client Phone
Patient Information
Patient Name
*
Breed
Species
*
Canine
Feline
Other
Patient Sex
*
Spayed Female
Neutered Male
Intact Female
Intact Male
Patient Date of Birth, or Age (in years)
Weight
Clinical Information
History/Chief Complaint
Physical Findings
Laboratory Data (Please attach copies of data below)
Tentative Diagnosis/Rule outs
Were X-rays taken?
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Treatments/Medications (please upload additional records below)
Case Summary/Comments
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