Patient Referral Form

When referring your patient to our hospital, please complete this form along with all pertinent medical records. Also, please ensure that you contact the doctor that will be managing the case at Burrard Animal Hospital + Emergency to ensure continuity of care.

Request *


Type Of Referral *






REFERRING VETERINARIAN INFORMATION

CLIENT INFORMATION

PATIENT INFORMATION


Please Include: Brief History & Treatments

DOCUMENTS


Please upload: Medical Records, Lab Results & Radiographs.



Burrard Animal Hospital + Emergency will not be contacting the owner of the referred patient until all medical records are received.
 


 

Security Question *