Petworks Veterinary Hospital - Referral Form

Referral Form

When referring your patient to our hospital, please complete this form and upload all pertinent medical records.
Please select the type of referral:*

Required documentation / information
Affected Limb:*

LeftRightBilateralFrontHind
Tentative Diagnosis:*
Present Complaint:*
Required documentation:
- Pre-Anesthetic Bloodwork (Chem 15/CBC/Lytes)
- Complete medical records
- Radiographs
Please note that we have started performing bloodwork on the morning of surgery for many of our procedures. Bloodwork done ahead of time at the regular clinic will be reviewed by the surgeon and is still recommended to rule out other comorbidities.
Upload Required Documentation:*

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Additional Information / Comments:
Should be Empty: