Referring Veterinarian Resources

Our staff is available to answer questions 24/7. Dr. Moeser is in the office Monday-Friday between 9:00am and 6:00pm, other times for emergencies. Please call 262-923-9894.

Referral information may be submitted online (below), or downloaded and sent electronically (info@wisconsinanimalneuro.com)

Client Name

Client Email

Client Phone Number

Patient Name

Patient Species

Dog Cat

Patient Sex

MN MI FS FI

Patient Breed

Presenting Complaint/History

What Diagnostics Have Been Performed (please email a copy to info@wisconsinanimalneuro.com or attach below)

Upload diagnostics here

Referring Clinic Name

Referring Doctor’s Name

Referring Clinic’s Phone

Referring Clinic’s Fax

Referring Clinic’s Email

Downloadable Referral Form

Download a PDF of the Referral form here.

Download the PDF

Downloadable Referral Form​

Looking for Pricing?

Downloadable Referral Form