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.

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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.