Internal Medicine - New Patient Form - Oxford Veterinary Hospital

First and Last Name:*

Spouse / Co-Owner:

Street Address:*

City, State and Zip Code:*

Primary Name & Telephone Number:*

Email:*

I understand that I am requesting an appointment with an Internal Medicine Specialist for a second opinion or complicated condition.*

Yes - I would like an appointment with the Internal Medicine Specialist
No - Please schedule an appointment with a general practitioner (not the Internal Medicine Department).

Our Internal Medicine Specialist, Dr. Raghu, has advanced training in complicated conditions including (but not limited to) endocrine, kidney, liver, pulmonary, gastrointestinal, auto-immune, and infectious diseases. Dr. Raghu is proficient in complicated ultrasounds, endoscopy, and laparoscopic procedures if further diagnostics are recommended.

How would you like us to contact you?*

Select All
Text
Phone call
Email

If this is an urgent need, please give us a call instead of filling out this form. Otherwise we will reach out to you within one business day to schedule the appointment.

Is there a day of the week and/or time of day you prefer for your appointment?*

Select All
Mondays
Wednesdays
Thursdays
mornings (8am-12pm)
afternoon (1:30-4:30pm on M/W, or 1:30-5:30pm on Th)

Our Internal Medicine Specialist's regular non-emergent appointment days are on Mondays, Wednesdays, and Thursday afternoons. Please indicate if there is a day or time preference or any are acceptable. If you have a specific date in mind or any other specifications, please note that in the box below. Dr. Raghu is also available for emergencies on Tuesdays and Fridays depending on availability. Please CALL if you need an appointment urgently.

Do you have a specific date(s) that you prefer (M, W, or TH afternoon for non-emergent appointments)? (ie, Dec 3-15, 2027)

Pet's Name:*

Please Indicate:

Dog
Cat
Other

Breed:

Color:

Birthdate or age:*

Sex:

Male
Male Neutered
Female
Female Spayed

Name of Referring Veterinary Practice:*

Referring Veterinarian Name:

Has your pet seen another internist or specialist? If so, which specialty hospital?

Patient history

What is the Primary Reason for your pet coming in:*

If your pet is experiencing any of the following symptoms, please check all that apply:

If you would like to elaborate on anything or any symptoms, please put anything you think is important for us to know:

Diagnostics recommended?

Are there specific diagnostics that your family veterinarian would like your pet to have done with our specialist (such as abdominal ultrasound, endoscopy, fine needle aspirate, biopsies, special labwork, etc)?

Current medications:

Please indicate the drug name, size of tablet or concentration of liquid, how much you are giving and how often. For example: amlodipine 2.5mg tab - one tab once daily

Current diet and treats:

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Internal Medicine New Patient

Patient history

After the online form is submitted, we will reach out to you within one business day to schedule the appointment.