REFERRAL AGREEMENT

YOU HAVE BEEN REFERRED TO KIMBERLY CREST VETERINARY HOSPITAL AS AN EXTENSION OF YOUR PRIMARY CARE. A referral from the Animal Emergency Center of the Quad Cities is considered an extension of your primary care veterinarian. You have been referred here because your pet's condition is not routine, but more complex. Your companion may have already had tests performed and possibly treatment given.

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WITH YOUR APPROVAL, WE WILL FOLLOW THROUGH WITH TESTING AND MEDICAL CARE UNTIL YOUR PET IS RECEIVING THE BEST TREATMENT FOR HIS/HER INDIVIDUAL NEEDS. One of Kimberly Crests veterinarians will review your companion's history including the most recent tests and treatments given and make recommendations for your pet.

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WHEN WE HAVE COMPLETED TREATMENT, YOUR PET WILL RETURN TO YOUR PRIMARY CARE VETERINARIAN.

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AN INFORMATIVE REPORT WILL BE FAXED OR MAILED TO YOUR PRIMARY CARE VETERINARIAN ONCE THE CASE IS EITHER COMPLETED OR AT THE APPROPRIATE POINT WHEN HE/SHE NEEDS TO BE ADVISED OF TREATMENT.

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AS A REFERRAL CLIENT, ANY FUTURE VISITS NOT RELATED TO THIS APPOINTMENT WILL REQUIRE A REFERRAL BY MY CURRENT PRIMARY CARE VETERINARIAN. THIS AGREEMENT APPLIES TO THIS PET, MY OTHER PETS, AND ANY FUTURE PETS I MAY HAVE.

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By signing below, I understand that my pet has been referred to Kimberly Crest Veterinary Hospital for a specific problem by my primary care veterinarian or the Animal Emergency Center by extension. This establishes me as a "referral" client at Kimberly Crest Veterinary Hospital. I understand that any other problems, primary care, and/or routine vaccinations will continue to be performed by my primary care

I also understand all payments are due at the time services are performed or products are received. A monetary deposit may be necessary before beginning some procedures.

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