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. Please print out the referral form, fill it out legibly, and return by fax to 423-622-8145.

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 423-698-4612 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.

Download our VCA Referral Form

Referral Form

All fields are required unless otherwise stated

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Services Requested
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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
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Patient Details
Sex
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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