Veterinarian Referral

Veterinarian Referral
PLEASE DO NOT PRINT THIS FORM. IT IS DESIGNED TO BE FILLED OUT ONLINE.

Printed forms will not be accepted.
Update as of February 2025:

Due to the large demand for behavioural care, we are unable to accept new patients for the foreseeable future.

If patients need behavioural care, please book a vet-to-vet consultation or refer to the clinics below. Both doctors are behavioural residents, Dr. Caunce travels to the Lower Mainland from time to time and both offer virtual consultations.

Dr. Eva Dudzic: http://www.kindheartvetbehaviour.com , info@kindheartvetbehaviour.com

Dr. Serena Caunce: Tri Lake Animal Hospital & Referral Centre, 250-766-3236, https://vcacanada.com/trilake/specialty/referral-form
Referral type*

Vet-to-Vet consultation
NEW for Vet-to-Vet Consultations Jan 2025: Once an appointment has been confirmed, we will send an email with a link to a behaviour history form for you to forward to the client - Dr. Richter will now review this form for the consultation. This will have to be received 5 days before the consult or the consult will be cancelled with no exceptions - please make sure your client submits this form as soon as you receive it, we do not send reminders to the client. Your clinic will receive a confirmation email once the form was submitted to us as well as a copy of the form.

Referring Veterinarian Information
Information on vet-to-vet consultations:

Calls typically last between 20 and 30 minutes. Dr. Richter will propose a diagnosis and treatment plan for the patient, provide a brief overview of behaviour modification strategies, and recommend a qualified trainer in the area to implement behaviour modification. If Dr. Richter and the attending DVM jointly decide that a case is not suitable for treatment within the scope of general practice, we are currently only able to refer those to Dr. Caunce or Dudzic for direct care in BC.

It is important to note that the responsibility for ensuring an accurate diagnosis and for decisions on the prescription of medications lies with the attending DVM. The patient remains under the care of the referring clinic, not Dr. Richter and the client needs to be informed of this. Dr. Richter is a consultant to the attending DVM, and no contact will be made with the client.
Referring Veterinarian Name*
Clinic Name*
Clinic Email*
example@example.com
Clinic Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Clinic Phone*
Please enter a valid phone number.
IMPORTANT INFORMATION ON BILLING FOR VET-TO-VET CONSULTS:

Payment Method: Payment is accepted only through CREDIT CARD via the invoice 2 days before the consult. NO OTHER PAYMENT METHODS will be accepted. Exceptions cannot be made.

Please ensure that you inform your accounting department about this policy to facilitate a smooth billing process.

Your understanding and cooperation in adhering to these guidelines are greatly appreciated.
Email to send invoice to*

Same as aboveOther
Please provide a number for us to reach the attending DVM on the day of the appointment. This number needs to be available even if the clinic is closed over lunch or the DVM is not at the clinic. *
We have a limited time for the call. If we cannot reach the DVM within 5 minutes of the scheduled time, the appointment will have to be rescheduled and a cancellation fee will apply.

Client Information
Client Name*

First NameLast Name
Client Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Client Email - please make sure the email address is up to date as this is how we contact the client to book the consultation. *
example@example.com
Client Cell Phone Number*
Please enter a valid phone number.
Other Client Numbers
Please enter a valid phone number.

Patient Information
Species*

CanineFelineOther
Name*
Breed*
Colour/Markings*
Age*
Sex*

FemaleFemale SpayedMaleMale Neutered
Weight (in kg)*

Patient History - Vet-to-Vet Consultation
Briefly describe MEDICAL history - focus on chronic disorders, episodes of pain or gastrointestinal disease; DO NOT send medical records, they will not be reviewed*
List ALL CURRENT medications and supplements. INCLUDE DOSES and SIDE EFFECTS.*
List any PREVIOUS behaviour medications or supplements tried with effect on condition and side effects. INCLUDE DOSES.*
Briefly list BEHAVIOURAL problems you are aware off - Dr. Richter will review the client history form prior to our consult. *

	I confirm
The consultation is between Dr. Richter and the attending DVM, the client is not permitted during the call. No advice will be given directly to the client from Dr. Richter or her team.
Please tell your clients that Dr. Richter is NOT prescribing medications, making diagnoses and that their pet is NOT under her care.
The referring veterinarian is responsible for providing relevant patient information, including medical history, diagnostic test results, and any other pertinent details required for a comprehensive discussion.
NEW for Vet-to-Vet Consultations Jan 2025: Once an appointment has been confirmed, we will send an email with a link to a behaviour history form for you to forward to the client - Dr. Richter will now review this form for the consultation. This will have to be received 5 days before the consult or the consult will be cancelled with no exceptions - please make sure your client submits this form as soon as you receive it, we do NOT send reminders to your client and appointments will be cancelled without exception if the form is not received. Your clinic will receive a confirmation email once the form was submitted to us as well as a copy of the form.
As the attending DVM, you should review the behavioural history for the patient yourself, and not rely solely on Dr. Richter to suggest a diagnosis - this is your responsibility and you should be aware of what the problems are.
The patient and their medical/behavioural care remain the responsibility of the attending veterinarian, and it is the attending veterinarian's duty to assure whether recommendations made during the consultation are appropriate for the individual patient.
All patient information shared during the consultation is confidential and should be treated as such. Both parties agree not to disclose or share patient details without explicit consent.
A summary report and any supporting materials will be provided within 48 hours after the consultation.
Cost of our consultation (150$ plus GST) will be charged directly to you
Changes to scheduled appointments must be communicated in advance. Cancellations within less than 48 hrs will be charged in full, rescheduling is subject to availability and will be charged again.
Payment is processed only through credit card on the invoice. There are no exceptions, please clear this with your accounting department before booking a consult.
Follow up can be booked as needed, cost is 125$ plus GST
You are aware that if the case is deemed complicated, until November 2024, Dr. Richter will not be able to take the case for direct behavioural care. All patients will either need to stay with you or be referred to Dr. Dudzic or Caunce.

Veterinarian Referral

Referring Veterinarian Information

Client Information

Patient Information

Patient History - Vet-to-Vet Consultation

Patient Medical and Behavioural History

Terms of Service