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Mainely Veterinary Dentistry

Providing high quality dental care services for cats and dogs.

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Phone:(207) 481-8232

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Veterinarian Referral Form

Step 1 of 4

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Name

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

Referring Doctor Practice Information

Doctor Name(Required)

First Last

Practice Name(Required)

Practice Address(Required)

Street Address Address Line 2 City State ZIP Code

Practice Phone(Required)

Practice email(Required)

Owner Information

Owner Contact Name(Required)

First Last

Owner Phone(Required)

Owner Email(Required)

Owner Address(Required)

Street Address Address Line 2 City State ZIP Code

Patient Information

Patient Name(Required)

First

Patient Date of Birth (if known) or estimated age(Required)

Patient Species(Required)

Patient Breed(Required)

Gender(Required)

Male

Male/Neutered

Female

Female/Neutered

Use(Required)

Pet

Obedience

Police

Hunting

Show

Breeding

Shutzhund

Service

Is the patient vaccinated for Rabies?(Required)

Yes

No

Too Young

Would this patient benefit from anti-anxiety medications prior to the appointment?

Yes

No

Dental specific concerns/relevant history. If there is an oral mass, when was it first noted and is it getting larger?(Required)

Notes

Please send ALL records including any radiographs, histopathology, dental xrays, and bloodwork via email to info@mainelyvetdentistry.com.

How did you hear about us?

Google search

Facebook

Instagram

LinkedIn

Event

Client

Newspaper

Word of Mouth/Colleague

Other

Call today to make an appointment or get a question answered

Hours of Operation

Monday 7:30am – 5:30 pm

Tuesday 7:30am – 5:30 pm

Wednesday 7:30am – 5:30 pm

Thursday 7:30am – 5:30 pm

Friday 7:30am – 4:00 pm

Saturday Closed

Sunday Closed

Call to make an appointment (207) 481-8232

Directions

Google Map Link

From the north (I-95)
Exit 63. Left onto US-202 W. Go 3.4 miles and left to stay on US-202 W. Go 3.7 miles to the rotary and take 3rd exit onto US-302 E. Go 2 miles and practice is on the right.

From the south (I-95)
Exit 48. Turn right onto Riverside Street. Go 1.5 miles and turn left onto US-302 W. Go 5.6 miles and practice is on the left.

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Mainely Veterinary Dentistry, LLC

158 Roosevelt Trail, Windham, ME 04062

info@mainelyvetdentistry.com

© 2025 Mainely Veterinary Dentistry // Website Design: Barry Costa // Privacy Policy