Animal Dermatology Clinic of BC

Call Now! 1 604-558-3376

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Certified Specialist in Skin, Ear, Hair, Nail and Allergies

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Veterinarian Referral Form

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*
Pet’s 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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Thank you for entrusting the Animal Dermatology Specialists of Vancouver with your dermatology specialty needs. We will be sending you a typed report, this will include a diagnosis, the tests that were performed and a recommended course of action.

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

Richmond
140-8040 Garden City Rd
Richmond, BC
604-558-3376

Langley
306-6325 204th St
Langley, BC

604-558-3376


Coquitlam

812 Roderick Ave
Coquitlam, BC

604-558-3376

 
*PLEASE HAVE YOUR CLIENT CALL US TO SET UP AN APPOINTMENT*

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