CSU Cancer Care Appointment Request Form

For a cancer care appointment, please fill out this appointment request form. The information you provide helps us ensure your pet receives timely, individualized care. We will respond to your appointment request within 24-48 business hours with next steps. Thank you for trusting us with your pet’s care!

"*" indicates required fields

This field is for validation purposes and should be left unchanged.

Client Name*
Has your pet ever been a patient at CSU Veterinary Hospital?*
For any service, including primary care or oncology.
Have you ever had any other pets treated at CSU Veterinary Hospital?*
Address*
Are you interested in receiving text message appointment reminders?*

Pet Species*
Pet Sex*
Estimate is acceptable
MM slash DD slash YYYY

Please list the name(s) of your primary veterinary clinic and all other clinics that have seen your pet for the presenting issue. We will contact these veterinary clinic(s) for pertinent records in advance of your visit and will send records of your visit following care. Include hospital name, city, and state.
Hospital Name, City, State
Hospital Name, City, State
Consent for Records*
I give consent for the CSU Cancer Care team to contact my general veterinarian for my pet’s medical records.

Please describe the cancer diagnosis or concern for your pet:

If you have any photos or advanced imaging records you would like to share with us, please upload here.
Drop files here or
Accepted file types: jpg, gif, png, pdf, Max. file size: 64 MB.

    Consent to be contacted*

    Please allow 24-48 business hours for a response.