Dermatology Referral Form

*Indicates required fields

Please contact Capital City Specialty & Emergency Animal Hospital at (613) 244-7387 if you need assistance with any referral.

If the attachments surpass the maximum 50MB file size, please email the patient’s records and imaging directly to dermatology@capcityvet.com.

a white dog sitting in a grassy area

REFERRAL DETAILS

0 of 5000 max characters

REFERRING VETERINARIAN INFORMATION

CLIENT INFORMATION

PATIENT INFORMATION

FILES

Please be sure to separately attach copies of any relevant lab work performed by outside labs that may not otherwise be included in the Medical Record (eg biopsies, cultures).

The following files are attached:

Max. file size: 50 MB.
Max. file size: 50 MB.
Max. file size: 50 MB.
Max. file size: 50 MB.