Referral Form

If you are a client’s regular veterinarian and wish to transfer a patient to Central Island Veterinary Emergency Hospital for overnight care, further diagnostics, or other, please complete this form. Once received, we will return an estimate for you to present to the client, so they have an idea of the approximate cost of care and the services provided.

If you have any questions about the referral of specific cases, feel free to phone ahead and speak to one of our veterinarians.

REFERRING VETERINARIAN INFORMATION

PATIENT INFORMATION

If appropriate, please prescribe the patient trazodone and/or gabapentin for clients to administer prior to surgical appointments.

CLIENT INFORMATION

DOCUMENTS

Please upload your blood work and any other relevant records here:
Click or drag files to this area to upload. You can upload up to 20 files.
Maximum size of 20 MB per file.
Please select all that apply.

Thank you for taking the time to complete this form. A member of our team will be in contact with you as soon as possible.