Referring Veterinarian (if applicable)

Dr. Name *

Hospital Name *

Email Address *

Phone *

Fax

What is the best way to reach you? *

Owner Information

Client (Owner) First Name *

Client (Owner) Last Name *

Client (Owner) Phone *

Client (Owner) Email

Client (Owner) Address

Patient Information

Pet Name *

Pet Species / Breed *

Sex *

Male

Female

Age *

Medical Information

What issue are you referring for? *

Summary of Clinical History *

Tentative Diagnosis Given to Client *

Current Medications *

Additional Comments

Supporting Information

Additional letter / information will be sent with client?

Yes

If yes, what will be provided?

Medical Records

Radiographs (X-Rays)

Images

Synopsis Letter

Other

Upload Copy of Patient's Medical Records *

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Upload Radiographs (X-Rays)

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Upload Bloodwork

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Upload Other

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Additional Comments

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Exotics Referrals

Caring for Pets in Atlantic Canada

Our specialists are pleased to accept new patients by referral from primary care veterinarians. Our emergency service welcomes all clients – 24/7/365.