How to Refer a Case

Please contact Dr. Garrett Levin and Ascend Veterinary Surgery, PLLC via phone or email if you would like to have a surgical consultation and schedule surgery. Complete the form below to submit a case online.

Referring Veterinarian's Information
Referring Veterinarian's Name:
Referring Veterinarian's Phone:
Hospital Name:
Client's Information
Client's Name:
Home Phone:
Work Phone
Cell Phone
Email Address
Address
Street Address Address Line 2 City State ZIP Code
Patient's Information
Patient's Name:
Breed
Age:
Untitled
Spayed / Neutered?
Weight (lbs):
Patient's History
Client Complaint/History:
Clinical Problem/s:
Laboratory and/or Radiograph Results:
Medications:
What surgical procedure would you like to schedule?
If you have already scheduled the surgery - please list the date below. If surgery has not been scheduled - please list 3 potential dates that work for your hospital and we will be in touch with you.
Attach a File
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How to Refer a Case

Referring Veterinarian's Information

Client's Information

Patient's Information

Patient's History