Vet Referral

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About Us
Services
Referring a Client
Forms
Contact
Privacy Policy

Home
About Us
Services
Referring a Client
Forms
Contact
Privacy Policy

Refer a Client

Refer a Client

Home
About Us
Services
Referring a Client
Forms
Contact
Privacy Policy

Home
About Us
Services
Referring a Client
Forms
Contact
Privacy Policy

Patient Information

Pet Name(Required)

Age(Required)

please specify if age is in years or month

in YEARS

in MONTHS

Gender(Required)

M (n)

F (s)

Species / Breed(Required)

Weight (kg)(Required)

Client Information

Client Name(Required)

First Last

Primary Client Phone(Required)

Secondary Client Phone

Email(Required)

Address

Street Address Address Line 2 City Province Postal Code

Referring Hospital Information

Referring Hospital(Required)

rDVM Phone(Required)

rDVM Name(Required)

First Last

rDVM Email(Required)

Is this an emergency?

Yes

Your Patient's Medical History

Please included patient history, medical findings, images, or other files.

Documents Included:(Required)

Medical Records

Lab Results

Radiographs

None

Other

Other Documents(Required)

Upload File(s) Here

Drop files here or

Accepted file types: pdf, doc, docx, jpg, gif, png, Max. file size: 128 MB.

Documents Will Be Sent Via(Required)

Uploaded

FTP / URL

with Client

PACS (Preferred for X-Ray)

Courier

Other

Other Method(Required)

Presenting Concern(Required)

Health Status & Medications(Required)

Include behavioural concerns, medical alerts, or history of seizures or drug reactions. Please include your clinical findings and impressions of the case, any recent laboratory tests, imaging findings etc. These can be uploaded.

Current Diet(Required)

Current Medication(Required)

Has muzzling or sedation been required for examination of this patient?(Required)

Yes

I consent to the use and storage of my information in accordance with the terms and conditions detailed in the privacy statement.(Required)

I consent to the use and storage of my information in accordance with the terms and conditions detailed in the privacy statement.

I agree to the terms and conditions

hCaptcha

Clinic Hours:

Tues-Friday: 8:00 am – 6:00 pm
Sat-Sun: Closed

After Hours Emergency:

Guardian Veterinary Centre
780-436-5880

Pulse Veterinary Specialists
and Emergency
780-570-9999

Vet ER (Thurs-Mon)
825-480-4881

Contact:

780-964-4747
team@pvds.ca
10822 124 st nw, Edmonton AB T5M 0H3

CALL 780 964 4747