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Please call for an appointment Small Animal Large Animal Referring Vet Direct Line 785-532-5690 785-532-5555 VHC Service Requested Cardiology Ophthalmology Exotics Dermatology Oncology Clinic Name Address City State Zip Code Telephone Fax Email Client s Name Phone Number Patient Name Age Breed Sex Reason for referral Vaccination status On routine medication heart worm thyroid others Yes No Med. Type Current therapy include dates and dosages History Physical findings Problem/Tentative...
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