General Referral Form

Important Notice About Referral Scheduling: Due to an increase in referral volume, we have implemented a triage protocol to help us prioritize patient care based on urgency. READ MORE >>

Our rehabilitation referral services have now resumed. We’re happy to welcome patients back and appreciate your patience.

When referring your patient to our hospital, please complete this form and upload all pertinent medical records.

REFERRING VETERINARIAN INFORMATION

Hospital Name *

Clinic/Hospital Phone Number *

Clinic/Hospital Fax Number *

Clinic/Hospital Email *

Name of Referring Veterinarian *

CLIENT INFORMATION

Full Name *

Name of secondary contact and/or spouse

Address *

City *

Province *

Postal Code *

Phone Number*

Email Address *

PATIENT INFORMATION

Patient's Name *

Birth Date *

Approximate

Age *

In months/years, or birthdate

Species *

Breed *

Colour / Markings *

Sex *

Weight *

In kg

Vaccine Status: *

Underlying Condition: *

REQUIRED DOCUMENTATION / INFORMATION

Present Complaint: *

Please note that we have started performing bloodwork on the morning of surgery for many of our procedures. Bloodwork done ahead of time at the regular clinic will be reviewed by the surgeon and is still recommended to rule out other comorbidities.

Relevant Documentation:

Security Question *

I HAVE READ AND UNDERSTOOD THE PRIVACY POLICY *