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Labwork Submission for Existing Referral
Radiograph Submission-Existing Referral
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Complete your Labwork Submission – Existing
Referral
form online!
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This form was submitted by:
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Referring Clinic:
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Email addresses you would like the HCVSS Dr. reply sent to:
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Referring DVM
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Patient Name
*
First
Last
Is this patient's surgery scheduled with HCVSS?
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Yes
No
If yes, what day is it scheduled for?
Were there any abnormalities on the bloodwork that could affect surgery?
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Yes
No
N/A
Notes
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