Chemotherapy recheck consultation
Choose this option if your patient has had an initial consultation and is actively in a VOP-designed chemotherapy protocol.  

​Every recheck consultation will require specific information that your team will need to collect while they are in the hospital, including history update, TPR, weight, and CBC.  ​Please download the file below, to print and have your staff complete the form to make sure they have everything you need to submit the recheck consult form.
VOP requires all supporting documentation to be submitted in an electronic format. This online form allows you to upload electronic copies of all medical records and labwork in a drag-and-drop format. VOP does not allow Email or Fax submissions at this time.  ​

Information required to complete this form:

  • Client and Patient Information (including patient weight)
  • Your hospital information (including phone, address, and email for reporting)
  • Updated History / Clinical Signs
  • Recent labwork (CBC required)
  • Diagnosis
  • List of previous chemotherapy protocols (if applicable)
  • Date of last chemotherapy administered (if applicable)
  • Current Medication
  • Date of last labwork
  • Recent labwork and any applicable imaging (radiographs / ultrasound) for attachment