Referrals - Draper Veterinary Services Inc

Veterinary Referral Form

Patients we see are referred to us by your veterinarian.

Referrals are submitted by your Veterinarian

Once a condition has been diagnosed your veterinarian will be able to contact us with details of the case using the PDF form attached below or use the online referral form.

Once we have received this information we will be able to contact you to arrange your consultation and surgery appointment if required.

For many standard problems we will be able to give an estimate of the surgery cost prior to the appointment time; however some more unusual conditions may require a consultation before an estimate can be prepared.

Referral Form (PDF)

Referral Form

Name

This field is for validation purposes and should be left unchanged.

Please select the type of referral

Orthopedic

Soft Tissue

Routine

Urgent

Veterinarian

Referring Veterinarian's Name(Required)

Practice Name(Required)

Veterinarian's Phone Number(Required)

Please enter the telephone number in the following format (###) ###-####

Veterinarian's Email Address(Required)

Client

Client's Name(Required)

Client's Address(Required)

Street Address Address Line 2 City Province Postal Code

Client's Email Address

Client's Phone(Required)

Please enter the telephone number in the following format (###) ###-####

Pet's Name(Required)

Species

Breed(Required)

Weight (KG)

Age

Gender

Male

Female

Spayed or Neutered?

Yes

Please describe the clinical findings, Ddx and any current medications or ongoing medical issues.(Required)

Please upload medical files, bloodwork, xrays, etc., here:

Drop files here or

Accepted file types: jpg, pdf, doc, docx, png, Max. file size: 256 MB, Max. files: 10.

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