REFERRAL REQUEST (Bellingham)

This referral form is for primary care veterinarians only.
Referral Request

4176 Meridian St, Bellingham, WA 98226 | Phone: 360-982-0166 | FAX: 1-888-867-6928 | bbvsh.com/bellingham | bellingham@bbvsh.com
Refer to:*

SurgeryOncologyCTCardiologyUltrasoundInternal MedicineRehabilitation
Type of referral*

UrgentNext Available
Referring Veterinarian
Referring Veterinarian
Referring Hospital*
Daytime Phone Number*
FAX Number
After Hours Phone Number
Clinic email address
Preferred Method of Contact

PhoneFaxEmail
Client Information
Name*

First NameLast Name
Home Phone*
Mobile Phone
Street Address
City
ZIP
Client email address
Patient Information
Patient Name*
Species*
Breed
Patient Sex

FMFSMN
Age*

MonthDayYear
Date
Reason For Referral
Current Concern(s) Requiring Referral*
eg. clinical history, PE findings, etc
Diagnostic Tests performed*
eg. lab reports, etc
Current Medications currently or previously given.*
Relevant Medical Records arriving by:

FaxEmailSent with Owner
File Upload
Click below to upload any supporting document or Radiographs. Please submit high resolution Radiographs. 10MB max file size per file

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Please Note

Please send all relevant records, lab results and diagnostic images. Once you have sent your referral, please contact our office to confirm receipt.

Phone: 360-982-0166 Fax: 1-888-867-6928
Should be Empty:

Referral Request