Animal Dermatology Clinic of BC

Call Now! 1 604-270-6199

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) 279-2040
    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 604-279-2040
     
    Case History  

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

    Treatment/Medications (Dosages & Durations)
     
    Thank you for entrusting the Animal Dermatology Clinic of BC 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.

    Richmond
    140-8040 Garden City Rd
    Richmond, BC
    604-270-6199

    Langley
    306-6325 204th St
    Langley, BC
    604-270-6199

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

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