Direct Referral Form
Thank you for trusting us as partners in the care of your patients! We value referrals from our veterinarian colleagues. At Highlands Eldorado, Dr. Wesley Taylor performs multiple types of surgeries (ACL/CCL, TPLO, Extracapsular Cranial Cruciate Ligament Repair, Tightrope Procedure, Modified Maquet Procedure (MMP), bone fracture repair, trauma surgery, soft tissue surgeries including splenectomy, perineal urethrostomy, cystotomy, etc.). If there is ever anything else we can do for you or your client, please let us know.
Date
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Month
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Day
Year
Date
Referring DVM
*
Referring Hospital Name
*
Client Name
*
First Name
Last Name
Client Phone Number
*
Please enter a valid phone number.
Patient Name
*
Age
*
Species
*
Breed
*
Sex
*
Male
Female
Spay/Neuter
*
Yes
No
Case Summary
*
Recent Lab Work
*
Yes
No
Recent Radiographs
*
Yes
No
IV Catheter
*
Yes
No
Fluids
*
Yes
No
Referring Veterinarians: Please upload any relevant patient medical documents.
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Email for Referral Confirmation
*
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