Telemedicine Examination Requests.Please fill out this form to request a Telemedicine Examination. Name of Horse * Breed * Age * Color * Sex * Owner Name * First Name Last Name Email * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Preferred contact method * (Call, text, or email) Primary veterinarian name * First Name Last Name Primary veterinarian hospital * Primary veterinarian email * Primary veterinarian phone number * (###) ### #### Patient diagnosis/history * Medications and frequency * Other info (Optional) Thank you for your message. We will get back to you soon.
