Dental Radiograph or Case Consultation FormDate: DD slash MM slash YYYY Referring Veterinarian InformationReferring Doctors Name:Name of Hospital:Hospital Phone Number:Preferred time to call: : Hours Minutes AMPM AM/PMHospital email address: Patient InformationName of Pet: First Species: Canine Feline Breed:Age/DOB DD slash MM slash YYYY Sex: Male Neutered Female Spayed Relevant 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 Select filesMax. file size: 256 MB.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.
