Referral Form

Veterinary professionals may fill out this form to request a consultation or to schedule surgery. Pet owners please click HERE to submit a request for more information from Dr. Frey.

SoftSurg is here to help!

If you need immediate assistance, or if the case is an emergency that needs attention within 12-24 hours, please send a text message directly to Dr. Frey at 858-333-2687! Dr. Frey will make every attempt to respond to submissions sent via this form within 48-72 hours.

This online case request form is to be filled out by veterinary staff only, please!

If you are a pet owner seeking additional information, please click HERE to send a message to Dr. Frey!

Hospital Name *

Hospital Phone Number *

Hospital Email Address *

Your Name and Position *

Referring Doctor *

What service do you need? *

An estimate for surgery
To schedule a surgery
A second opinion on a case
Other

If other, please explain

Client Last Name *

Patient Name *

Species *

Canine
Feline
Other

If other *

Breed *

Age in Years/Months (not DOB) *

Weight (Specify kg or lb) *

Gender

Intact Male
Neutered Male
Intact Female
Spayed Female

Is this a DVM or Employee personal pet? *

Please provide more details: *

Presenting Complaint *

Brief History *

Exam Findings *

Tentative Diagnosis *

Relevant Diagnostics Performed (please email results to tracy.frey@softsurg.com or upload below) *

Cytology
Biopsy
Radiographs
Ultrasound
MRI
CT Scan
Other

If other, please explain *

X-rays

Email tracy.frey@softsurg.com or upload X-rays here:

Click or drag files to this area to upload. You can upload up to 10 files.

Supported file types: .jpg, .jpeg, .png, .mp4, .mov (no zip files).

Medical Record & Diagnostics

Email tracy.frey@softsurg.com or upload medical record & diagnostics here:

Click or drag files to this area to upload. You can upload up to 10 files.

Supported file types: .jpg, .jpeg, .png, .pdf, .mp4, .mov (no zip files).

A cancellation fee of $300 will be charged if a scheduled procedure is cancelled or rescheduled within 36 hours (not to include Saturday or Sunday as SoftSurg is closed on weekends) of the scheduled surgery date. *

I have read and acknowledge the cancellation fee.

Signature *

Date *

Website

How Can We Help You and Your Pet?

We want to hear from you! Please use this online form or contact Dr. Frey directly via text or email.



Location

San Diego, CA



Contact Information

P: 858-333-2687
E: tracy.frey@softsurg.com

Name *

First

Last

Email *

Phone

How can we help you? *

Feel free to upload any photographs, medical records or diagnostics here:

Click or drag files to this area to upload. You can upload up to 10 files.

Please upload in JPEG or PDF format (no zip files).

Website