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(919) 303-3456
• Pet Resort & Spa:
(919) 323-8877
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Veterinarians
Jodi Reed, DVM
Charles Livaudais, DVM
Molly Shelton, DVM
Mikaela Archambeault, DVM
Corisa Cheston, DVM
Kelsi Ferris, DVM
Katelyn McSpadden, DVM
Jordan Samia, DVM
David Schur, DVM
Jazlyn Sharp, DVM
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About
Veterinarians
Jodi Reed, DVM
Charles Livaudais, DVM
Molly Shelton, DVM
Mikaela Archambeault, DVM
Corisa Cheston, DVM
Kelsi Ferris, DVM
Katelyn McSpadden, DVM
Jordan Samia, DVM
David Schur, DVM
Jazlyn Sharp, DVM
Staff
Ambassadors
Hours & Policies
Reviews
Hospital
Preventive & Wellness
Diagnostics & Treatment
Medication & Pharmacy
Common Pet Poisons Guide
Dental Care (COHAT)
Rehabilitative Therapy
Pet Insurance
Hospital Reviews
Resort & Spa
Pet Grooming & Spa
Dog Boarding
Dog Daycare
Cat Boarding
Resort Vaccination Requirements
Pet Resort Photo Wall
Harmony Pet Resort & Spa Reviews
Emergency
Resources
Blog
Newsletters
Harmony Animal Rescue Clinic
Cat Life Stages & Care
Dog Life Stages & Care
Videos
If You Have Lost Your Pet
Products
Common Pet Poisons Guide
Pet Insurance
Recommendations & Referrals
Contact
Patient Portal – Appointments
Forms
Client Records Request
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Veterinarian Combined General Surgery Referral Form
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Veterinarian Combined General Surgery Referral Form
Veterinarian General Surgery Referral Form
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*
" indicates required fields
Client Information
Owner Name:
*
First
Last
Primary Phone:
*
Secondary Phone:
Pet Information
Patient Name
*
Patient info:
*
Age
Breed
Color
Patient Sex:
*
Female
Spayed Female
Male
Neutered Male
Species (Dog or Cat)
*
Weight
*
Veterinarian Information
Name of Veterinary Hospital:
*
Doctor Name
*
Mr.
Mrs.
Miss
Ms.
Dr.
Prof.
Rev.
Prefix
First
Last
Veterinarian Phone:
*
Procedure for which patient is being referred. You may choose more than one.
*
COHAT due to periodontal disease
Full mouth extractions due to stomatitis or periodontal disease
Partial matxillectomy or mandibulectomy for oral cancer
Cleft palate repair
Retained tooth root extraction
Oronasal fistula repair
Extracapsular repair (additional details required below)
Medial patellar luxation (additional details required below)
Brachycephalic airway surgery which may include stenotic nares repair, elongated soft palate resection, everted laryngeal saccule resection
Laparoscopic ovariectomy
Laparoscopic assisted gastropexy
Laparoscopic cryptorchid neuter
Laparoscopic liver biopsy
Upper GI endoscopy and biopsy due to chronic gastrointestinal illness
Endoscopic gastric foreign body removal
Mass removali
Limb or digit amputation
Cystotomy
Perineal urethrostomy
Video otoscopy with deep ear lavage, culture, and biopsy if indicated
Rhinoscopy with biopsy, including anterior and posterior approach
Other (additional details required below)
If Extracapsular Repair:
Right Leg
Left Leg
If Medial Patellar Luxation
Right Leg / Grade 1
Right Leg / Grade 2
Right Leg / Grade 3
Right Leg / Grade 4 *Please note we do not accept referrals for Grade 4 medial patellar luxation repair or lateral luxation repair
Left Leg / Grade 1
Left Leg / Grade 2
Left Leg / Grade 3
Left Leg / Grade 4 *Please note we do not accept referrals for Grade 4 medial patellar luxation repair or lateral luxation repair
If "Other" please explain:
Known intolerance to any medications such as NSAIDs, Gabapentin, Trazodone, or certain antibiotics? Please explain:
*
Related health concerns affecting anesthesia such as brachycephalic airway disease, heart disease, history of regurgitation or aspiration pneumonia, hypertension, chronic kidney disease, liver dysfunction? Please explain:
*
Behavioral concerns which may affect examination, medication administration, IV catheter placement, or recovery from anesthesia? Please explain:
*
Any other information you wish to provide which may be helpful to us in caring for your patient and in working with your client:
*
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