Dear Referring Provider:

The detailed completion of this form is very important to help us better assist you and your patient.

A consult cannot be provided without completion of this form.

If you have any questions or issues regarding this form or the consult process, please contact our dermatology staff at vetderm@umn.edu or (612) 624-4831.

Please note that it may take up to 72 hours (3-business days) for a dermatologist / dermatology resident to respond to your consult, unless you note below that the case is urgent.

The first 3 sections of this form are question/answers about you, your client/patient demographic information and the patient's history. Upon completion of the consult form you will be directed to a page where you may provide us with photographs of your patient's disease or other pertinent medical records documents.