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Referring Veterinarians
LVVD
4580 Crackersport Rd
Allentown, PA 18104
(610)391-1200
To schedule an appointment,
click here
or call 610-391-1200
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Form - Referral Form
Referring Veterinarian Name
(required)
Hospital Name
(required)
Referring Vet E-Mail
(required)
:
Owner Name
(required)
First Name
(required)
Last Name
(required)
Owner Phone
(required)
Phone Type
Phone Number
(required)
Cell
Fax
Home
Work
Pet Name
(required)
Species :
dog
cat
other
Breed
Sex
MC
FS
F
M
Date of Birth
Has the owner already scheduled an appointment?
yes
no
unsure
Appointment Date
Records can be faxed to 610-391-1212 or emailed to referral@lehighvetderm.com
Case History
Diagnostic Tests/Results
Treatments and Response (please indicate current treatment)
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Verification Code :
Enter the code you see in the graphic below in this box.
Your post will not be allowed if you do not type this in correctly.
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