Bay Area Veterinary Specialists Referral Form (Cardiology, Internal Medicine and Oncology)

12855 Gulf Freeway Houston, TX 77034

281.464.3554

Ext 1: Surgery Department

Veterinary Surgical Group, LLP

Ext 2: Cardiology, Internal Medicine, Oncology

Veterinary Medical Specialists of Houston

Ext 3: Ophthalmology

Gulf Coast Animal Eye Clinic

Referral Form (Cardiology, Internal Medicine and Oncology)

Veterinary Medical Specialists of Houston - Cardiology, Internal Medicine and Oncology

Thank you for referring your valued client and their pet to our practice. In order to facilitate the referral process, we ask you or your staff to complete the below form if you wish. We also ask
1. Please send all pertinent medical records via email prior to their appointment or with the client. You may also print and fax this form with the medical records.
2. Please ask your client to bring their pet, all current/recent medications, radiographs or other imaging data to their appointment.
Referring Veterinarian*
Clinic Name*
Client Name*
Pet Name*
Pet Age*
Client Phone Number*
Client Email*
Requested Department*
- Cardiology
- Internal Medicine
- Oncology
How soon does patient need to be seen?*
- Emergent
- Within one week
- Soonest available
Brief History/Reason for Referral*
We ask that all clients arrive 20 minutes prior to their scheduled appointment to ensure they will have their full appointment time with the doctor.

You should receive a written faxed referral report within 24 hours of the patient being discharged from the hospital. Please let us know if you would like an alternate method of delivery or you would like additional information.
Name
This field is for validation purposes and should be left unchanged.

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