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?NoYesPatient InformationPet's Name(Required) Owner's Last Name(Required) Species(Required) Breed(Required) Age in years(Required) Sex(Required)Male IntactFemale IntactMale DesexedFemale DesexedWeight in kg(Required) DiagnosisPlease paste in or attach a copy of biopsy/cytology reportDiagnosis Files Drop files here or Select files 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 Select files Max. file size: 64 MB. CBC, Chemistry Profile, UA performed?NoYes – ( Describe or attach files )CBC, Chemistry Profile, UA resultsCBC, Chemistry Profile, UA files Drop files here or Select files Max. file size: 64 MB. Other blood tests?NoYes – ( Describe or attach files )Blood test ResultsBlood test files Drop files here or Select files Max. file size: 64 MB. Regional lymph node evaluation?Not enlargedNot evaluatedAspirated (describe or attach files)Biopsied (describe or attach files)EnlargedRegional lymph node resultsRegional lymph node files Drop files here or Select files Max. file size: 64 MB. Bone marrow evaluation?NoAspirate (describe or attach files)Biopsy (describe or attach files)Bone marrow evaluation resultsBone marrow evaluation files Drop files here or Select files Max. file size: 64 MB. RadiographsNoYes (Describe or attach files)Radiograph resultsRadiographs Files Drop files here or Select files Max. file size: 64 MB. Ultrasonography?NoYes (describe or attach file)Ultrasonography resultsUltrasonograph files Drop files here or Select files Max. file size: 64 MB. Any other imaging?NoYes (describe or attach file)Other imaging resultsOther imaging files Drop files here or Select files Max. file size: 64 MB. Cardiac evaluation?NoYes (describe or attach file)Cardiac evaluation resultsCardiac evaluation files Drop files here or Select files Max. file size: 64 MB. Current drug therapy and/or response to previous medications?NoYes (describe or attach file)Drug therapy and/or response to previous medications resultsDrug therapy and/or response to previous medications files Drop files here or Select files Max. file size: 64 MB. Other pertinent medical history?NoYes (describe or attach file)Other pertinent medical history detailsOther pertinent medical history files Drop files here or Select files Max. file size: 64 MB. Additional comments or specific questions?NoYes (describe or attach file)Additional comments or specific questions detailsAdditional comments or specific questions files Drop files here or Select files Max. file size: 64 MB.