"*" indicates required fields

NOTE: This form is intended to be filled out only by a referring DVM or hospital representative. Owners should seek referrals from their DVM.

One of the Dermatologists will contact you to discuss this consult typically within 24-72 business hours (Monday thru Friday, 8am - 4pm). Please note, our hours may vary during federal holidays and UGA Fall and Winter Breaks. This consult form is used for doctor-to-doctor communications only. If you would like to make a formal referral, please contact our client care team at 706-542-3221. Please send any clinical images to vetderm@uga.edu. (These are very important for us to help assist you)

Consulting Veterinarian Information

Preferred Method of Contact*

Patient and Owner Information

Owner Name*
Is this a current patient of UGA’s Small Animal Dermatology Service?*

Current Medications

We’re UGA Vet Med, and our

passion powers our commitment.