Referring veterinarians

We are sincerely grateful to the primary care veterinarians throughout Connecticut and the surrounding states who refer their veterinary dermatology cases to us. Please use this form to refer a patient to us, and note that this form is not mandatory: clients are welcome to simply book an appointment with us if you have nothing to add beyond what is documented in your records.

We are also happy to answer any dermatology-related questions that you have about your own patients. Please email these questions to info@unleashedvetderm.com, and we will reply within 24 business hours.

Referring Veterinarian name

Referring Veterinarian Email

Referring Veterinarian Phone #

Contact preference

Email Phone

Owner name

Owner email

Owner phone #

Is this an emergency?

Yes No

Pet name

Dog Cat

Reason for referral

Relevant history, non-dermatologic

Relevant laboratory tests performed (ie, biopsy performed and date, culture performed and date-- no need to list specific results as long as records are attached)

Current medications

Past medications

Recommendations for handling (e.g. muzzle, sedation)

Please upload relevant medical records. If you don't want to upload them here, our office will be happy to contact yours to obtain them.

Referring veterinarians

Phone

Stratford, CT

Schedule

Pharmacy