Consultation Request Form

Save time at your next appointment! Please complete your required Consultation Request Form online from any device at any time before your visit.

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Consultation Request Form

Please complete this form completely and accurately.

Primary Care Hospital *

Primary Care Veterinarian *

Hospital Phone *

Hospital Email *

Owner Name *

First

Last

Phone *

Alternate Phone

Email Address *

Pet Name *

Age/DOB *

Weight *

Color *

Species *

Breed *

Gender *

Male
Female

Has your pet been spayed or neutered? *

Reason you are requesting a consultation *

What diagnostic tests has your DVM performed for this problem: (Choose all that apply) *

Bloodwork
Urinalysis
Radiographs (X-rays)
Biopsy
Aspirate
Other:

If Other Please Specify *

Does your pet have any known medical problems (eg. Allergies, diabetes, hypothyroid, Cushings, etc) *

Has your pet had any anesthesia or medication complications? *

Dr. Collins sees consultations on Monday mornings in Brockport, and every other Tuesday morning in Buffalo. Please choose which office you would prefer your consultation at *

Brockport Office: 24 East Avenue, Brockport, NY, 14420

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Contact Information

Phone: (833) 455-8736
Email: info@vetsurgicalspecialist.com

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Hours

Mon, Tues, Thurs, Fri: 8 AM – 3 PM
Wed, Sat, Sun: Closed