H&M VetSurg is a mobile surgical service for veterinary hospitals. We do not see patients directly, give treatment advice to pet owners, or quote prices to owners. If your pet needs surgery, please ask your veterinarian about a referral.

Refer a Case

Mobile Veterinary Surgery Referral Form

Specialty Surgery Services provided by Hani M Korani DVM, DACVS-SA

SECTION 1: Referring Veterinary Clinic Information

Clinic Name*

Referring Veterinarian*

Clinic Address*

Clinic Phone*

Clinic Email*

Preferred Contact Method*

Urgency of Referral*

Date of Referral*

Patient Information

Patient Name*

Species*

Bsystem resBreed*

Age*

Weight*

Sex*

Microchip Number

SECTION 3: Case Information

Reason for Referral / Working Diagnosis*

Desired Procedure*

Case History Summary*

Relevant Physical Exam Findings*

Current Medications & Dose

Diagnostics & Imaging

Others

Diagnostic Reports*

Radiographs/Images*

Link to DICOM/Images (if applicable)

Refer a Case

Mobile Veterinary Surgery Referral Form

Specialty Surgery Services provided by Hani M Korani DVM, DACVS-SA

SECTION 1: Referring Veterinary Clinic Information

Patient Information

SECTION 3: Case Information

Diagnostics & Imaging

Testimonials

What Pet Owners Say About Us

Testimonial 1

Testimonial 2

Refer a Case

Mobile Veterinary Surgery Referral Form

Specialty Surgery Services provided by Hani M Korani DVM, DACVS-SA

SECTION 1: Referring Veterinary Clinic Information

Patient Information

SECTION 3: Case Information

Diagnostics & Imaging

Testimonials

What Pet Owners Say About Us

Testimonial 1

Testimonial 2

Thank you!