Request a Consultation

Attention: if you are having issues with the new online form, please contact us at voc@vetoncologyconsults.com and you are welcome to download the pdf request form (below) to submit your consultation via email. Thank you!

Please also note that the upload limit size has increased to 64MB but if your attachments are too large to submit here, feel free to email them separately.

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.

Name of Veterinarian(Required)

Veterinary Practice(Required)

Practice Administrator / Billing Contact Person(Required)

Email Address for Billing(Required)

Address(Required)

Please include City, State, Post Code and Country.

Phone Number(Required)

Email Address for Reports(Required)

How would you like us to respond?(Required)

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)

Do you require a copy of this consultation without billing information included?

Patient Information

Pet's Name(Required)

Owner's Last Name(Required)

Species(Required)

Breed(Required)

Age in years(Required)

Sex(Required)

Weight in kg(Required)

Diagnosis

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

Diagnosis Files

Drop files here or

Max. file size: 64 MB.

History relating to current cancer(Required)

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

Drop files here or

Max. file size: 64 MB.

CBC, Chemistry Profile, UA performed?

CBC, Chemistry Profile, UA results

CBC, Chemistry Profile, UA files

Drop files here or

Max. file size: 64 MB.

Other blood tests?

Blood test Results

Blood test files

Drop files here or

Max. file size: 64 MB.

Regional lymph node evaluation?

Regional lymph node results

Regional lymph node files

Drop files here or

Max. file size: 64 MB.

Bone marrow evaluation?

Bone marrow evaluation results

Bone marrow evaluation files

Drop files here or

Max. file size: 64 MB.

Radiographs

Radiograph results

Radiographs Files

Drop files here or

Max. file size: 64 MB.

Ultrasonography?

Ultrasonography results

Ultrasonograph files

Drop files here or

Max. file size: 64 MB.

Any other imaging?

Other imaging results

Other imaging files

Drop files here or

Max. file size: 64 MB.

Cardiac evaluation?

Cardiac evaluation results

Cardiac evaluation files

Drop files here or

Max. file size: 64 MB.

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

Drop files here or

Max. file size: 64 MB.

Other pertinent medical history?

Other pertinent medical history details

Other pertinent medical history files

Drop files here or

Max. file size: 64 MB.

Additional comments or specific questions?

Additional comments or specific questions details

Additional comments or specific questions files

Drop files here or

Max. file size: 64 MB.

Request a Consultation

Patient Information

Providing the highest possible quality of life for pets.

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