Referral Form

Collaborative Veterinary Referrals for Advanced Care & Emergency Services in Ottawa–Gatineau

Clinic/Hospital Name

Email

Phone

Referring Veterinarian

Pet's Name

Pet's Age

Species

Canine Feline

Sex

Spayed Female Neutered Male Intact Female Intact Male

Specific Services Requested:

Specialist-Reviewed Ultrasound Emergency Care Surgery Dental Care Overnight Hospitalization

Reason for Referral

Initial Diagnostic Tests Performed

Blood Work X-rays Ultrasound Urinalysis Cytology

Would you like to remain involved in the treatment plan?

Additional Notes

Client's Name

Client's Email

Client's Phone

Client's Address

Dr. Vetamin's facilities are accredited by CVO

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