Patient Referral Form

We believe in a team-focused approach to veterinary medicine. Working with referring veterinarians helps us maintain the highest patient care standards and provide outstanding client service. While we work on dermatologic and allergy concerns for our patients, we expect that routine veterinary services (health check-ups, vaccinations, etc.) will continue to be provided through the primary veterinarian.

To refer a patient, please complete and submit the Patient Referral form, either online or by fax or e-mail. We encourage you to give us a call if you would like to briefly discuss the case before patient referral or if you have any questions or concerns.

Once the referral has been received, a vet dermatologist consultation will be scheduled with the pet owner. Following the consultation, we will communicate with the primary veterinarian’s office directly in order to provide a complete record and referral report of your patient.

Date of Referral (Select or Use YYYY-MM-DD):
OWNER INFORMATION
PATIENT INFORMATION
REFERRING VETERINARIAN INFORMATION
Desired method of referral report delivery:
FaxE-mail
STATUS OF REFERRAL
Non-urgentUrgentEmergency
DESIRED LOCATION OF CONSULTATION
In House (Client consult & Patient evaluation at referring clinic)Vancouver Satellite (Intercity Animal Emergency Clinic)Coquitlam Satellite (Central Animal Emergency Clinic)Victoria Satellite (Downtown Veterinary Clinic)
Reason for Patient Referral (Case Summary):
Diagnostics, Treatments and Response to therapy:(Please attach any diagnostic or laboratory reports)
Other Systemic/Non-Dermatologic Disease:
Special Requests or Expectations:

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