Online Consultation Form For Veterinarians

Attention: due to an unprecendented high caseload, we are unable to accept consultation requests from veterinary practices that are not already established clients with us, until further notice.

Note: This form will not save text and uploaded files until it is submitted. Please ensure that you complete the form in a single session or use the paper based form.

Please provide the following contact information:

Name of Veterinarian *

Practice Administrator / Billing Contact Person *

Email Address or Fax Number for Billing *

Veterinary Practice *

Address *

Please include City, State, Post Code and Country.

Phone Number *

Fax

Email Address for Reports *

How would you like us to respond? *

Email ($250)

Fax ($250)

Phone ($275)

(Follow-up consultations for ongoing case management - $35)

Do you need:

Chemotherapy protocol ($40) (if custom-designed, $70)

Information on drug handling and administration ($15 each)

Would you like to receive additional information?

Client information sheets on treatment type and protocol ($15 each)

Client information sheet on tumour type and behaviour ($15)

Patient information

Pet's Name *

Owner's Last Name *

Species *

Age in years *

Breed *

Sex *

Weight in kg *

Diagnosis

Please paste in or attach a copy of biopsy/cytology report

Diagnosis files

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Files must be less than 5 MB.
Allowed file types: gif jpg jpeg png bmp eps tif pict psd txt rtf html pdf doc docx ppt pptx xls xlsx xml bz2 dmg gz jar rar sit tar zip.

History relating to current cancer *

Please provide a summary of pertinent details including clinical signs, tumour size, duration, location, etc. If sending the medical record please also include a summary to orient us to the cancer problem.

Cancer History files

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Files must be less than 5 MB.
Allowed file types: gif jpg jpeg png bmp eps tif pict psd txt rtf html pdf doc docx ppt pptx xls xlsx xml bz2 dmg gz jar rar sit tar zip.

CBC, Chemistry Profile, UA performed? *

CBC, Chemistry Profile, UA results

CBC, Chemistry Profile, UA files

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Files must be less than 5 MB.
Allowed file types: gif jpg jpeg png bmp eps tif pict psd txt rtf html pdf doc docx ppt pptx xls xlsx xml bz2 dmg gz jar rar sit tar zip.

Other blood tests? *

Blood test results

Blood test files

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Files must be less than 5 MB.
Allowed file types: gif jpg jpeg png bmp eps tif pict psd txt rtf html pdf doc docx ppt pptx xls xlsx xml bz2 dmg gz jar rar sit tar zip.

Regional lymph node evaluation? *

Regional lymph node results

Regional lymph node files

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Files must be less than 5 MB.
Allowed file types: gif jpg jpeg png bmp eps tif pict psd txt rtf html pdf doc docx ppt pptx xls xlsx xml bz2 dmg gz jar rar sit tar zip.

Bone marrow evaluation? *

Bone marrow evaluation results

Bone marrow evaluation files

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Files must be less than 5 MB.
Allowed file types: gif jpg jpeg png bmp eps tif pict psd txt rtf html pdf doc docx ppt pptx xls xlsx xml bz2 dmg gz jar rar sit tar zip.

Radiographs? *

Radiograph results

Radiographs files

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Files must be less than 5 MB.
Allowed file types: gif jpg jpeg png bmp eps tif pict psd txt rtf html pdf doc docx ppt pptx xls xlsx xml bz2 dmg gz jar rar sit tar zip.

Ultrasonography? *

Ultrasonography results

Ultrasonograph files

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Files must be less than 5 MB.
Allowed file types: gif jpg jpeg png bmp eps tif pict psd txt rtf html pdf doc docx ppt pptx xls xlsx xml bz2 dmg gz jar rar sit tar zip.

Any other imaging? *

Other imaging results

Other imaging files

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Files must be less than 5 MB.
Allowed file types: gif jpg jpeg png bmp eps tif pict psd txt rtf html pdf doc docx ppt pptx xls xlsx xml bz2 dmg gz jar rar sit tar zip.

Cardiac evaluation? *

Cardiac evaluation results

Cardiac evaluation files

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Files must be less than 5 MB.
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Current drug therapy and/or response to previous medications? *

Drug therapy and/or response to previous medications results

Drug therapy and/or response to previous medications files

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Files must be less than 5 MB.
Allowed file types: gif jpg jpeg png bmp eps tif pict psd txt rtf html pdf doc docx ppt pptx xls xlsx xml bz2 dmg gz jar rar sit tar zip.

Other pertinent medical history? *

Other pertinent medical history details

Other pertinent medical history files

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Files must be less than 5 MB.
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Additional comments or specific questions? *

Additional comments or specific questions details

Additional comments or specific questions files

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Files must be less than 5 MB.
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About Us

We're all about providing the best possible quality of life for pet animals with cancer and their human families.

More about us

For Veterinarians

Information, conversion charts and templates to help you manage treatment in your patients.

For Pet Owners

We understand how difficult it can be to have a pet diagnosed with cancer so we've put together some answers to common questions.

Get in touch

Veterinary Oncology Consultants

voc@vetoncologyconsults.com

+61 0459952124