Referring Veterinary Clinic Request for Consultation Request for ConsultationPlease fill out the form below to schedule a consultation for your client/patient. Please note that if you need immediate assistance to schedule an appointment, or if this is an emergency, please call us at 801.683.6201. Thank you!Please enable JavaScript in your browser to complete this form.Referring Veterinary Clinic *Referring Veterinarian *Referring Clinic Email *Reason For Consultation *Consultation to be scheduled with: *Dr. Jeff Simmons (Emergency and Critical Care)Dr. Andrew Burton (Surgery)Dr. Melanie Thompson (Internal Medicine)Dr. Mark Langheinrich (Emergency)UnknownPatient / Case Information and History *Consultation Type Requested *Consultation at Mountain West Veterinary SpecialistsDiagnostics Only at rDVMPlease let us know if you are looking to have the consultation done at MWVS, or if you are wanting diagnostics only performed at your clinic (please note traveling fee may apply). Requested Date of ConsultationPlease note that we will try to accommodate the date requested; however, cannot guarantee availability. Requested Time of ConsultationMorning (8:00 AM to 12:00 PM)Afternoon (12:00 PM to 5:00 PM)Misc. NameSubmit