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. Learn more about our COVID-19 response and guidelines.
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Please contact us to find out more about referring patients.

VCA Referral Form

Please complete this simple form so that we can efficiently address your clinical concerns and your pet's problems.

Download our VCA Referral Form.

Referral Form

All fields are required unless otherwise stated

Some information is missing. Please see below for details.

(optional)
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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
(optional)
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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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