Refer a Patient

To ensure comprehensive care, all behavior consultations are by veterinary referral only. Please complete the form below to refer a patient for a behavior consultation.

Please note that certain aggressive patients may be deferred to NCSU Behavioral Medicine (aggression towards children, severe bites or injuries to people or animals).

Referring Veterinarian Information

Referring Veterinarian*

Clinic Name*

Client Information

Client Name*

Client Address*

Client Email*

Patient Information

Patient Name*

Species*

Date of Birth or Age*

Weight (lb or kg)*

Primary Concern

Primary Concern*

Refer a Patient

Contact form

Referring Veterinarian Information

Client Information

Patient Information

Primary Concern