We are committed to caring for your pet – while maintaining the highest level of safety for our Associates and pet owners. We thank you for your continued patience and support. 
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Please contact us to find out more about referring patients.

VCA Hollywood Animal Hospital Referral Form

In order to help our veterinary staff accurately assess your patient's current health status, we ask that prior to referral you please complete our REFERRAL FORM located at the link below. Our referral form is interactive, please type your responses directly into the form, save to your computer, then submit along with relevant medical records, by email to: [email protected] or you may also print out the referral form, fill out legibly, and return by fax to 954-920-4716.

A member of our team will contact you shortly to facilitate further communication and expedite your patient's care.

Please include pertinent medical records or images with the referral form.

If you need additional assistance, have questions or wish to discuss your patient's case prior to referral, please call our hospital at 954-920-3556 and a member of our staff will be happy to direct you to the appropriate doctor.

Thank you for choosing us to partner in your patient's care.

Referral Form

All fields are required unless otherwise stated

Some information is missing. Please see below for details.

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.

Some information was missing. Please see above for details.

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