THE BARN DOOR VETERINARY CARE-Platelet-rich plasma (PRP) therapy referral form

Platelet-Rich Plasma (PRP) therapy

Referral form -Veterinary Clinics only
Referral: Please fill out the form below. If you have any questions, please contact us directly at (604) 227-3111 or email info@barndoorvet.ca.

Purpose: To provide Platelet-rich plasma (PRP) therapy services to support local veterinary practices while maintaining the referring veterinarian's role as the primary care provider.

Scope of Service:

Platelet-rich plasma (PRP) therapy is performed by a trained veterinary professional. No other treatment, diagnosis, or case management will be provided by The Barn Door.

The Barn Door reviews the case to confirm it falls within our scope and if accepted, our team will contact the client directly to schedule the procedure. On appointment day, the patient is received by Barn Door staff; the client does not enter the facility.

All patients require fasting, we will provide fasting instructions (via email) to clients prior to admission.The referring clinic remains responsible for any additional client communication, diagnosis and treatment. All questions and follow-up care are directed back to the referring clinic

Collaboration Philosophy: We are committed to supporting local practices through transparent, respectful partnerships that prioritize patient care and preserve the integrity of the client-veterinarian relationship.

Please fill out and submit the form below:
Referring Clinic Name*
Referring Veterinarian*
Email*
example@example.com
Phone *
example@example.com
Owner information
Owner Name*
Phone*
Format: (000) 000-0000.
Email*
example@example.com
Patient information
Patient Name*
Species
Sex
Breed*
Age*
Weight*
Pre-Visit Pharmaceuticals (PVP's)-Will you be providing PVP's to your patient for this procedure (Y or N?) If yes, please provide dosage(s). *
Medical History
NSAID'sGabapentinCartrophenLibrelaSteroidsJoint SupplementsPhysical rehabilitationSurgeryOther
ElbowShoulderStifle (Knee)HipCarpusTarsusTendon / LigamentSoft Tissue InjuryOsteoarthritisPost-surgical healingCorneal UlcerDentistry
LeftRightBilateralOther
RadiographsBloodworkCT / MRI ReportSurgical ReportRehabilitation NotesOther
File Upload

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Working Diagnosis:
Duration of Condition:
Signature

Clear
Date

MonthDayYear
Date
Attachments required. Please email us the most recent medical notes, relevant lab work, radiographs to: info@barndoorvet.ca

By submitting this form, I confirm that I am the primary veterinarian for this patient and authorize The Barn Door Veterinary Care to perform an outpatient PRP therapy treatment. I understand that all records will be sent directly to our clinic, and that The Barn Door will not provide treatment or case management.
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Platelet-Rich Plasma (PRP) therapy