Veterinarian Referral Form

 

I,_____________________________ (LICENSED VETERINARIAN’S NAME) a legally Licensed veterinarian

 in the state of  ______________________________________________________________
do hereby request Dr. Thomas E. Allen of Patterson, MO,
to perform dental services on horses under my regular veterinary care at the following location/s:

 

 

 


 

_______________________________________________________
(LICENSED VETERINARIANS SIGNATURE)


______________________________________
(DATE SIGNED)
 

Veterinarian’s address:_________________________________________________

______________________________________________________________________

______________________________________________________________________

Phone #_______________________________________________________________

Email address:_________________________________________________________

Please email or snail mail to Dr. Tom Allen tallen@horsedentist.com

Or snail mail to: Route 1 Box 176E Patterson, MO 63956

www.horsedentist.com     1-573-856-4005

Dr. Allen welcomes veterinarians to observe client’s horses receiving dentistry.
Please let us know if you would like to join Dr. Allen &/or if you would like a copy of the dental chart/s to
discuss the work and/or findings. Dr. Allen only does dentistry.

Many veterinarians refer dental work to Dr. Allen, preferring not to becoming involved in offering their own
equine dentistry service as it involves additional, expensive, equipment, course work, study & experience to many veterinarians
that are already busy with their practices. We welcome your referrals.

Illustrations are the property of Elsevier Science and may not be used without the permission of the publisher.
Copyright Elsevier Science 2003

 

© Copyright 2007 Dr. Tom Allen, horsedentist.com - All Rights Reserved