Neurology Clinical Trial Consultation Request
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To begin the enrollment process, referring veterinarians or owners may complete this form. Please note that a current MRI confirming the likely diagnosis of a brain tumor is necessary to determine eligibility. After you or your veterinarian completes the form, please email a copy of your dog's MRI report to email@example.com.
Date of Birth (if unknown, please include approximate age)
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Your relationship to the dog
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