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 72 business hours (Monday through Friday). Your “Hospital Email Address” will receive a confirmation that this Referral Form has been successfully received – if you do not receive this confirmation form, please reenter the submission. If you have not heard a response from Dr. Frey within 72 business hours, please feel free to reach out directly!

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 *

(This is the address to which Dr. Frey's emailed response will arrive.)

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 Full Name *

Client Email Address *

Client Cell Phone Number *

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 a non-profit rescue organization paying for this pet's surgery?

Is FACE foundation paying for this pet's surgery?

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:

Drag & Drop Files, Choose Files to Upload You can upload up to 10 files.

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

Medical record, diagnostics & photos or videos

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

Drag & Drop Files, Choose Files 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 *

Clear Signature

Date *

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How Can We Help You and Your Pet?

We want to hear from you! Pet owners can use this online form to contact Dr. Frey directly! If you are a veterinary hospital staff member looking to refer a case to SoftSurg, please click HERE to use the Referral Form instead!

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Location

San Diego, CA

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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:

Drag & Drop Files, Choose Files to Upload You can upload up to 10 files.

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

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