*PLEASE NOTE* The 2024 Price List is available under the “Referring Vets” tab.

Let’s get on the same page

Mobile surgery requires collaboration.

We are committed to providing excellent surgical care with Anchor — the same level of quality that we provide in specialty hospitals. Our ability to do so depends DIRECTLY on the quality of information that we receive. Please bear this in mind as you complete this form on behalf of our future shared patient.

* Incomplete submissions will result in scheduling delays *

We’ll be in touch to schedule surgery as soon as we receive complete referral information and diagnostics. If you have not heard from us by the following business day, please check your email Spam Folder and give us a call.

Please review the “Before Surgery” section of our workflow summary with your team to ensure that they’re prepared for our arrival on Surgery Day.

PRINT WORKFLOW SUMMARY

REQUIRED DIAGNOSTICS:

* Pre-anesthetic bloodwork for all cases (Please share results even if WNL)

                 CBC/Chemistry Profile
                      Ill:     within 2 weeks of surgery
                      Healthy: within 2 months of surgery

* Pre-operative radiographs for all orthopedic cases

How to take TPLO rads

Please attach relevant radiographs & lab work results. **Full medical records will not be reviewed -- relevant details should be described below.**

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Referring Veterinarian Information

Referring Veterinarian's Name

First Name

Last Name

Hospital Name

Contact Email

Email address we'll use to communicate about the case, confirm the mobile surgery visit the day before, and provide Surgery Paperwork + Invoice.

Hospital Phone

(###)

###

####

Client Information

Client Name

Patient Information

Patient Name

Age

Breed

Sex

Weight (in kilograms)

If your practice records weight in pounds, please divide by 2.2 (1 kilogram = 2.2 pounds).

Chief Complaint & Relevant History

Briefly describe the reason why the patient presented for exam, the duration, the treatments attempted and response to therapy, etc.

Summary of Physical Exam Findings

Briefly describe the relevant exam findings that support your diagnosis.

Summary of Lab Results & Diagnostic Imaging

Identify any notable information found on diagnostic testing. Please attach the lab results even if results are "Within Normal Limits".

Diagnosis

Let's discuss if unsure. Please include the affected side (right vs. left) when relevant.

Current Medications

Nocita?

Nocita is a long-lasting local analgesic which helps to control pain during the critical inflammatory phase after surgery. Our fee is $325 per patient. If your practice stocks Nocita, our surgeons can administer it during surgery at no extra cost. Please select "No" and simply draw up the patient's dose sterilely from a new bottle on Surgery Day.

Yes (use Anchor stock)

Electronic signature of the veterinarian who has reviewed and confirmed the accuracy and completeness of this submission:

Name of person submitting this form:

Let’s get on the same page

REQUIRED DIAGNOSTICS:

* Pre-anesthetic bloodwork for all cases (Please share results even if WNL)

* Pre-operative radiographs for all orthopedic cases

Pet owners — Please contact your regular vet to see if mobile surgery is an option at their facility.