Veterinary Referral Form

Veterinarians:

Please fill out the form below to submit your referral request.

For urgent referrals please call (905) 829-9444.

Please note: You should receive a CC of the online referral form to the email address you entered in the form. If you do not receive confirmation of your submission, please call us at (905) 829-9444. Thank you.

Non-Veterinarians Including Pet Owners:

This form is for referrals from veterinarians ONLY. If you are a pet owner seeking a referral, please talk to your family veterinarian. We cannot respond to referral requests from non-veterinarians. We thank you for your understanding.

Referral Service

Please advise clients that the consultation fee will be in addition to the service or procedure fees. HST is added to all fees.

Urgent referral? Additional Fee: $80 to $300

To request a specific doctor please select from the list below. Otherwise we will provide you the first available.

Appointment Status*

Client to call to book appointmentAppointment already booked by veterinarian

Referring Clinic Information

Referring DVM:*

Referring Clinic:*

Referring Phone:*

Referring Fax:*

Referring Email:*

Client Information

Client Name:*

Client Phone:*

Additional Numbers:

Client Email:

Client Address:*

Client City*

Client Postal Code:*

Patient Information

Patient Name:*

Patient Breed:*

Patient Age:*

Patient Sex:*

Patient Weight (kg):*

Has this patient required muzzling or sedation during an examination?: NoYes
If yes, please describe:

To upload files, please scroll to the bottom of the form.

History:

Physical Exam:

Other Medical Issues:

Lab Tests and Findings:

Radiographic Findings:

Other Diagnostics:

Current Medications:

Current Diet:

Tentative Diagnosis:

Special Requests and Additional Comments:

Attach Testing/Diagnostics files:

To add a file, click on the button below.

Verification Code (required)

Please answer math questions with single digits. Do not spell the number.