Riverview AH - Patient Referral Form

Patient Referral Form

When referring your patient to our hospital, please complete this form along with all pertinent medical records. If this is an emergency which requires treatment within 24 hours, please contact our Emergency Doctor Team directly, 506-387-4015 press option 8. Also, please ensure that you contact the doctor that will be managing the case at Riverview Animal Hospital to ensure continuity of care.
Referral Policy

We kindly request that you follow these steps when referring a patient to Riverview Animal Hospital to ensure we provide the best possible care, quickly and efficiently.
1. Emergency Referrals - If your patient requires immediate medical care within 24 hours , please call the hospital to talk directly to our Emergency Doctor team, 506-387-4015.
2. Please complete the Patient Referral Form below and attach all pertinent Medical Records.
3. Non-Emergent referrals - Please complete the Patient Referral Form below and attach all pertinent Medical Records. One of our team members will contact the client to schedule an appointment with the appropriate department. Our Doctor Team will contact you directly should they require further information.
4. As a reminder all recheck appointments and medication refills are required to go to their referring Veterinary Hospital, with the exception of Orthopedics which will be followed until case completion. Medical Records will be sent back to your hospital with notes on timelines for rechecks.
Thank you for your referral. We appreciate your continued confidence in the services that we provide.
Which doctor are you referring your patient to?
Referring Veterinarian Information
Name of Referring Veterinarian *
Name of Referring Hospital *
Phone Number *

Area Code Phone Number
Cell Number

Area Code Phone Number
Email Address of Referring Veterinarian *
example@example.com
Best Time to Contact You
Patient Information
Client's Name *

First Name Last Name
Phone Number *

Area Code Phone Number
Patient's Name *
Date of Birth *
Species *
Breed *
Colour *
Sex (Spayed/Neutered) *
Reason for Referral
Reason for Referral *

Emergency / Hospitalization / Critical Care (please call our emergency team for referal) Medical Procedure (i.e. CT, Ultrasound, Endoscopy, etc.)
Select Procedure
Please note one of the following 2 timelines: A team member at RAH will call the client to set up appointments for Next Available and Urgent / Emergency requests.
Select Timeline *

Next Available - Patient is stable and can have procedure/appointment within the next 2 weeks. Urgent / Emergency - Communication has been made with our team and patient is on the way.
Overnight Hospitalization / Critical Care
Case Management to Conclusion
Patient Condition
Pertinent Medical History (Including Current Diagnostics/Treatments/Medications) *
Please send medical records, including Radiographs.
Patient's Medical Records

Browse Files

Cancel of
Preferred Communication *

I would like a call from the Doctor. Please book the appointment with the client.
Should be Empty:

Patient Referral Form

Referring Veterinarian Information

Patient Information