White Glove Service

Name: Harrisburg Regional Veterinary Surgical Specialty
Address: 989 East Park Drive, Suite A, Harrisburg, PA, 17111, United States
Telephone: 717-599-6131
Price range: $

In the interest of everyone’s safety, we are currently operating 100% curbside. Our White Glove Service provides the same excellent care to your pets, the difference is we are not allowing clients inside our building at this time. When you arrive at our center, please call us at 717-599-4259 and our team will provide you instructions for the next steps.

Referral Form

GET STARTED

Thank you for thinking of us!

This form should ONLY be filled in by a veterinary team member (i.e. not by a pet owner).
Then we’ll be in touch with you and your client ASAP.

Clinic Name *

Clinic Phone Number *

Referring DVM *

Clinic Email Address *

Client Name *

First

Last

Best Number to Reach Client *

Client Email Address

What service do you need? *

An estimate
A second opinion on a case
A second opinion on X-rays that I will send in JPEG format
To schedule a surgery
Other

If other, please explain *

Patient Name *

Species *

Canine
Feline
Other

If other, please specify *

Breed *

Age in Years/Months (not DOB) *

Weight *

Gender *

Male
Neutered Male
Female
Spayed Female

Is the patient up-to-date on vaccines? *

Is rabies up to date / when does it expire? *

(ex: Yes / 12-12-2024)

Any heart murmur? *

Any health concerns we should know about before anesthesia or surgery? *

If yes, please explain *

Summary of doctor's exam *

Please briefly explain patient's medical history *

Relevant medications (e.g. NSAIDs, steroids) *

Tentative Diagnosis *

Relevant lab work (FNA, biopsy) or radiology/ultrasound report available? *

If yes, please email to [email protected]

Have X-rays been taken? *

If yes, please email x-rays as JPEGs to [email protected]

Diagnostics Performed (please email results to [email protected] or upload below)

CBC
Chemistry
Radiographs
Ultrasound
Urinalysis
MRI
CT scan
Other

Please explain. *

X-RAYS MUST BE IN JPEG FORMAT.

Email Medical Record & Diagnostics to [email protected] or upload here:

Click or drag files to this area to upload. You can upload up to 10 files.

Signature *

Date *

Comment

We help your pet get back to feeling their best.

Harrisburg Regional Veterinary Surgical Specialty is the first and only local veterinary surgery center in the Harrisburg area. We partner with your family vet to provide your pet with surgical expertise in orthopedic, “soft tissue” and cancer surgery. All we do is surgery!

We proudly serve pets from Harrisburg, Mechanicsburg, Carlisle, Gettysburg, York, Lancaster, and Reading.

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Location

989 East Park Drive, Suite A
Harrisburg, PA 17111

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Contact Info

P: 717-599-6131
E: [email protected]

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Hours

By appointment only.

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We will be in touch with you!

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Have questions?

Click the button below or call us directly at 717-599-6131. We'll be here to answer any and all of your questions.

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