Dear Referring Veterinarians,

Please utilize our VCA Veterinary Referral and Emergency Center referral form located on
this web page when referring your patient to our hospital for veterinary services -- full instructions for completion and submission appear on the bottom of the form. If you have
any questions or require information or assistance of any kind, please don't hesitate to
contact us at 203-854-9960.

Thank you for your confidence and trust in VCA Veterinary Referral and Emergency Center.

The Doctors and Staff
VCA Veterinary Referral and Emergency Center
123 West Cedar Street
Norwalk, CT 06854
Tel 203-854-9960
Fx 203-838-5956


VCA VREC Referral Form

Download VCA VREC Referral Form

Referral Form

All fields are required unless otherwise stated

Some information is missing. Please see below for details.

(optional)
(optional)
Services Requested
(optional)
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(optional)
(optional)
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)
(optional)
(optional)
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.

Some information was missing. Please see above for details.

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