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Doctor Referral Form

Referral Process:

Please note that all medical notes must be sent along with this referral form, and all areas of this referral form must be filled out. Areas left blank, or a lack of medical records, may slow the process of your referral application or it may be declined. Along with submitting this form and the medical records, a veterinarian or RVT involved with the case must call PVEH and speak with one of our veterinarians or RVTs regarding the referral. These steps must be completed prior to the patient arriving at our facility to ensure a smooth transition of care.

Thank you for your understanding.
  • Referring Veterinarian Information:

  • Client Information:

  • Patient Information:

  • (Bloodwork, UA results, radiographs, ultrasound and other must be included with referral).
  • Drop files here or
  • (Include dosage, frequency, dates started, include all medication pet is currently taking including supplements, holistic therapy etc.) Eg. Metacam 5mg/mL Injectable – 0.1mg/kg dose – SQ left hind – June 1st at 1:00pm
  • (Eg. prior surgeries or procedures).
  • (Eg. Vaccinations, Flea/ Tick/ Deworming)
    Would the referring vet or clinic like updates on this patient while they are in our care if time permits?
  • NOTE:

    Records will be sent back to the referring clinic within 72 hours of the patient leaving our facility.