Request a Visit

If you have a patient that could benefit from our services, please submit the form below so we can review the case. We will follow up and help determine if surgery is the best option for your patient and schedule the appointment for us to come to your practice .

In most instances, we will directly schedule the surgical procedure. We may offer same-day consult and surgery if the diagnosis is not clearly evident.

Have we been to your practice before?

Requesting Veterinarian

First Name

Last Name

Phone

Best contact to discuss the case.

(###)

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Patient Name

First Name

Last Name

Species

If your patient is not a canine or feline please note we may decline services.

Sex

Patient Age (Years)

Patient Weight (lbs)

BCS (9 Point System)

Reference: https://www.aaha.org/wp-content/uploads/globalassets/02-guidelines/weight-management/weightmgmt_bodyconditionscoring.pdf

Summary of Concern / Requested Surgery

If you have links to x-ray images or records, please include them here.

Active Diagnoses

ASA Score

Reference: https://www.avtaa-vts.org/asa-ratings.pml

Acknowledgment of Practice Responsibilities

Obtaining CPR/DNR authorization and elective surgery authorization from client (VSx will provide forms). Pre-Anesthetic BW within 2 weeks of surgery date. Patient preparation for surgery. Providing your facility's surgical suite along with a veterinary technician to run and monitor anesthesia. Note: our surgeon may suggest or require appropriate anesthetic protocols.

Accepted and Acknowledged

Surgical Request Form

How it works

Once you submit the form, we will contact you to follow up within 24 business hours.

1.

Schedule with us.

We will consult over the phone and help determine if surgery is the best option for your patient and schedule the appointment for us to come to your practice for same-day consult and surgery.

We determine the price of the procedure and charge your practice directly.
Your practice generates the full patient invoice and charges your client as you normally would with any other service at your practice.

2.

Day of:

On the day of appointment or procedure, our surgeon and assistant will arrive at the scheduled time. We will call 30-60 prior to arrival to ensure appropriate hospital preparations are initiated.

3.

Your practice:

Preps the patient for surgery for our arrival.
Provides your facility's surgical suite along with a technician to run and monitor anesthesia.
Note: our surgeon may suggest or require appropriate anesthetic protocols.

4.

Our team:

Our team of surgeon and technician/assistant:

Brings with them all the necessary specialty instrumentation. We may request to use a basic/spay pack for some procedures.
Completes the surgical procedure and initial post-op care.
Provides a surgical report and post-op instructions.
The surgeon will call the client postoperative to discuss operative findings and postoperative care.