Please fill this information directly or as a provided PDF.  Dr. Atkinson is available for case discussion via phone or email to referring doctors or clients.

    Owner Name

    Referring Veterinarian

    Referring Hospital





    Owner Contact

    Primary Phone
    Primary Phone Type:

    Secondary Phone
    Secondry Phone Type:

    Work/Other Phone
    Work/Other Phone Type:

    Patient Information

    Pet Name

    Date of Birth

    Type of Pet




    History Reason for Referral

    Preliminary Diagnosis
    Other Medical conditions pet is currently being treated for.

    Current medications and date of initiation or most recent dosage change.

    Additional Information

    We request the last 6-12 months of relevant medical records, including all laboratory tests, chest radiographs and other diagnostic reports. Please send either directly to the owner, or via email at or via fax at (503) 433-1932.

    Radiographs are

    Radiographs will be promptly returned. Heart of Oregon Veterinary Cardiology will email or fax a copy of the discharge summary to you promptly. Dr. Atkinson is always available to speak with you about the case by calling (971) 727-3059 Monday through Friday