Dental Radiograph or Case Consultation FormDate: Referring Veterinarian InformationReferring Doctors Name:Name of Hospital:Hospital Phone Number:Preferred time to call: : HH MM AMPM Hospital email address: Patient InformationName of Pet: First Species: Canine FelineBreed:Age/DOB Sex: Male Neutered Female SpayedRelevant case history including clinical symptoms, oral findings and any specific concerns or questions you would like answered:Upload Relevant Case Files/Images: Drop files here or History of Dental Problems/Treatments:Please submit all dental radiographs and/or case images in JPEG format via our online portal or email.Consultation requests are reviewed within one business day of submission. If you have an urgent case, please call the Florida Animal Dentistry & Oral Surgery Center directly at (561) 515-6711.
