Thank you for your referral to VCA ASEC. In order to more easily allow transfers to our facility, we have referral forms, which may be downloaded and completed, in advance of sending the client.

To transfer a patient to the surgery department, please download the Surgery Patient Referral Form. Prior to their initial visit, please fax the referral form, along with records and laboratory results, to VCA ASEC at 310-479-8976.

If you are transferring a critical patient to our critical care/emergency department, you may download and complete the Critical Care Transfer Form to help specify your overnight treatment plan. This form may be faxed to VCA ASEC at 310-479-8976 or sent with the client for our emergency doctors.

We also have an imaging referral form, which may be downloaded and completed prior to transferring a client to our radiology department. We offer radiographs, ultrasounds and CT’s on an outpatient basis. Completion of this form will help to expedite the imaging process. It can be faxed to us at 310-479-8976.

Referral Form

All fields are required unless otherwise stated

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Services Requested
If available, please send the following with your client; patient information to include:
  • Medical Notes/Records
  • Imaging
  • Lab Work Results
  • Treatments, including last time administered
  • X-Rays
  • Other
Guardian Details
Patient Details
Tentative Diagnosis/Chief Complaint
History/Physical Findings (optional)
Treatment (including medications and dosages) (optional)
Special Requests/Comments (optional)
We respect your privacy and will not share your information with other parties. For more information, see the Privacy Policy.

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