Animal Dermatology Clinic of BC

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Certified Specialist in Skin, Ears, Hair, Nails and Allergies

Veterinarian Referral Form


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Download Veterinarian Referral form in PDF format
Download PDF
 
Fax form to (604) 558-3379
or fill out online version below
*Indicates mandatory field
  Date
 

PATIENT INFORMATION

Owner Name*
Phone*
Email*
Home Phone*
Cell or Pager*
Pets Name
Age*
Sex*

REFERRING HOSPITAL

Hospital Name*
Dr. Name*
Phone*
Fax*
E-Mail*
Records and Lab reports can be faxed to 604-558-3379
 
Case History  

Diagnostic Performed (please attach any laboratory and/or other diagnostic reports)

Treatment/Medications (Dosages & Durations)

 
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Vancouver
1316 West 4th Ave
Vancouver, BC
604-558-3376

Richmond
140-8040 Garden City Rd
Richmond, BC
604-270-6163

 
*Please inform your client they should be expecting a call from us to set up an appointment*

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