Skip to main content
Services
Companion Animal Clinic
Large Animal Clinic
Diagnostic Pathology Center
Companion Animal Clinic
Small Animal Services
Referral Information
623.806.7387 (PETS)
Large Animal Clinic
Equine
623.806.7575
Diagnostic Pathology Center
Anatomic Pathology
Biopsy & Postmortem Examinations
623.806.7540
About
Who We Are
Visiting Students
Faculty Directory
News
Newsletters
Insurance
Giving
Our Location
Directions
Contact
Send Us a Message
Sitemap
Animal Health Institute
Companion Animal Clinic
Contact
About
Legal
Sitemap
News
Large Animal Clinic
Diagnostic Pathology Center
Faculty Directory
Diabetes Management
Contact
About
Faculty Directory
News
Companion Animal Clinic
Pet Owners
Veterinarians
Large Animal Clinic
Diagnostic Pathology Center
× Close Panel
× Close
Referral Form
rDVM Referral
Clinic & Referral Details
Which service(s) are you referring?
*
Internal Medicine
Surgery
Neurology
Physical Therapy
Referring DVM
*
Clinic Name
*
Clinic Phone Number
*
Clinic Email Address
Preferred Contact Method
*
Phone
Email
Fax
Client Information
Client's Name
*
Client's Phone Number
*
Client's Email Address
*
Patient Information
Patient's Name
*
Species
*
Breed
*
Age
*
Weight (kg)
*
Sex
*
Male
Female
Patient Medical Background
Reason for Referral
*
Medical History or Clinical Findings
Previous Diagnostics
CBC
Chemistry
UA
Valley Fever Titer
Abdominal Ultrasound
Other (Cultures, fluid analysis, etc)
Other (Cultures, fluid analysis, etc)
Radiographs (Include views)
Radiographs (Include views)
Additional Surgical / Therapeutic / Medical Notes?
Medication History
Drug / Supplement
*
Dosage
*
Frequency
*
Duration of Therapy
*
Currently Taking?
Currently Being Taken
Add Another Medication
Remove Medication
× Close
Necropsy Request Form
Necropsy Submission
Veterinarian / Agency Information
Clinic Resource First Name
*
Clinic Resource Last Name
*
Suffix
Agency / Clinic Name
*
Veterinarian Email Address
Clinic Email Address
*
Clinic Phone Number
*
Clinic Fax Number
Clinic Address
*
Clinic Address
Clinic Address
Clinic Address
Clinic Address
Clinic Address
Alabama
Alaska
Arkansas
Arizona
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Clinic Address
Owner Information
Owner First Name
*
Owner Last Name
*
Owner Phone Number
*
Owner Email Address
Owner Address
*
Owner Address
Owner Address
Owner Address
City
City
State/Province
Alabama
Alaska
Arkansas
Arizona
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State/Province
Zip/Postal
Zip/Postal
Clinical History
Clinical History
*
Euthanized?
*
No
Yes, include route
Yes, include route
Death Information
*
Date / Time of Death
Date / Time of Death
Or, Last Time Known Alive
Or, Last Time Known Alive
Travel outside the U.S.?
*
No
Yes
Has this animal bitten anyone in the last 90 days?
*
No
Yes
Vaccinations, including rabies are up to date.
*
No
Yes
Special Requests?
Animal Information
Animal's Name
*
Animal ID
Microchip #
Date of Birth
Sex
*
M
CM
F
SF
Weight
*
Species
*
Breed
Color / Markings
Body Disposal
Body Disposal
*
Group Cremation
(Ashes NOT returned)
Private Cremation
(Ashes returned to referring vet)
General Body Disposal
Authorization
Reports are generally issued within 10 business days; however, if specialized testing is required this may take longer.
Submitting veterinarian/agency is responsible for cost of services provided and will be invoiced.
It is the responsibility of the submitting veterinarian to deliver results to the animal owners.
ONLY the Veterinarian/Agency will be sent the final report.
Owners will never be contacted in legal investigations.
Authorization
*
I confirm that the owner/agent has given consent for their animal to undergo a full postmortem exam (necropsy). I confirm that the owner/agent has given consent for the animal or tissues to be made available for research and educational purposes. I understand the submitting veterinarian/agency is responsible for all fees associated with this submission.
Authorized Printed Name
*
Date Authorized
Legal Investigators
Is this a legal case?
*
Yes
No
Investigating Police Department
Case Number
Officer / Detective
Phone Number
Email Address
A copy of your submission will be emailed to you. Please print and include when arriving for exam.
× Close
Biopsy Request Form
Biopsy Request
Veterinarian / Agency Information
Clinic Resource First Name
*
Clinic Resource Last Name
*
Suffix
Are you a new client?
*
Yes
No
Agency / Clinic Name
*
Clinic Phone Number
*
Clinic Email Address
*
Clinic Address
*
Clinic Address
Clinic Address
Clinic Address
Clinic Address
Clinic Address
Alabama
Alaska
Arkansas
Arizona
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Clinic Address
Owner Information
Owner First Name
*
Owner Last Name
*
Owner Phone Number
*
Owner Email Address
Owner Address
*
Owner Address
Owner Address
Owner Address
City
City
State/Province
Alabama
Alaska
Arkansas
Arizona
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State/Province
Zip/Postal
Zip/Postal
Animal Information
Animal's Name
*
Animal ID
Microchip #
Date of Birth
*
Sex
*
M
CM
F
SF
Weight
*
Species
*
Breed
Color / Markings
Medical Information
History / Clinical Features
*
Same Details
*
10% Formalin
Other
Other
Previous Biopsy
*
No
Yes, include date
Yes, include date
Ventral Biopsy Site
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Dorsal Biopsy Site
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
Sample Specs
Jar #
*
Type
*
Excisional
Punch
Needle
Sample Site
*
Tissue Type
*
Add
Remove