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Dr. Jason Reeder
Dr. Gretchen Kuchenmeister
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What to Expect At Your Dog’s Appointment
Your Dog’s Procedure
At Home Care For Dogs After Procedure
Anesthesia and Monitoring For Dogs
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What to Expect at Your Cat’s Appointment
Your Cat’s Procedure
At Home Care For Your Cat After Procedure
Anesthesia And Monitoring For Cats
Benefits of Minimally Invasive Procedures
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Interventional radiology and endoscopy procedures
Referral Form
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Home
About
Mission and Goals
Dr. Jason Reeder
Dr. Gretchen Kuchenmeister
Meet Our Staff
Clients
Canine
What to Expect At Your Dog’s Appointment
Your Dog’s Procedure
At Home Care For Dogs After Procedure
Anesthesia and Monitoring For Dogs
Feline
What to Expect at Your Cat’s Appointment
Your Cat’s Procedure
At Home Care For Your Cat After Procedure
Anesthesia And Monitoring For Cats
Benefits of Minimally Invasive Procedures
Client Center
New Client Form
Policies and Procedures
Referring Veterinarians
Interventional radiology and endoscopy procedures
Referral Form
Procedures
Contact Us
Hours
(503) 567-8835
19056 Willamette Drive
West Linn, OR 97068
Referral Form
Referral Form
This form is to be completed by the referring veterinarian.
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Referring Veterinarian
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Referring Hospital
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Street Address
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City
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Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
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
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Referring Veterinarian Phone
(Required)
Fax
Referring Veterinarian Email
(Required)
Other primary or consulting veterinarians and clinics
(Required)
Patient Information
Name
(Required)
Species
(Required)
Dog
Cat
Date of Birth or Approximate Age
(Required)
Breed
(Required)
Gender
(Required)
Intact male
Neutered male
Intact female
Spayed female
Body weight (indicate lbs or kgs)
(Required)
Referral Information
Consult requested with
(Required)
Dr. Kuchenmeister (Soft Tissue Surgery)
Dr. Reeder (Internal Medicine)
Both
Pertinent medical history
(Required)
Differential diagnoses
(Required)
Completed diagnostic tests
CBC
Chemistry profile
Thyroid testing
Other bloodwork (specify)
Urinalysis
Radiographs
Diagnostic ultrasound
Culture
Cytology
Histopathology
CT
MRI
Echocardiography
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Current medications
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Current diet
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Services/procedures requested
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