Request an Orthopedic Consult

Orthopedic Consult Form

Thank you for choosing Viking Veterinary Hospital for your pet’s surgery. Allow us to proceed with your pet’s care by completing our required orthopedic consult form.

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Orthopedic Consult Form

We are proud to work with Dr. Dan Richardson, who works out of our Nampa location, to offer orthopedic surgery options. If you are interested in a consult with Dr. Richardson, please fill out this form as completely and accurately as possible so we can best prepare for your pet’s procedure.

Orthopedic Consult Form

Note: This resource should be used in addition to a consultation with your veterinarian. This form is not intended to be used as an initial diagnostic or consultation.

Client Information

Client Name *

First

Last

Phone Number *

Email *

Patient Information

Pictures Age Name

Patient Name *

Species/Breed *

Age *

Referring Veterinarian

Veterinarian Name *

Clinic Name *

Medical Details

Description of Injury / Concern: *

File Uploads (Optional but highly recommended)

Upload Pictures

Click or drag a file to this area to upload.

Upload Radiographs

Click or drag a file to this area to upload.

Submission Agreement *

I understand this form is for information-gathering purposes only and is not a substitute for an in-person exam or initial consultation with a veterinarian.

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Request an Orthopedic Consult

Orthopedic Consult Form

Orthopedic Consult Form

Orthopedic Consult Form

Client Information

Patient Information

Referring Veterinarian

Medical Details

File Uploads (Optional but highly recommended)

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