Patient Referral Form

When referring your patient to our hospital, please complete this form along with all pertinent medical records. If this is an emergency which requires treatment within 24 hours, please contact our Emergency Doctor Team directly, 506-387-4015 press option 8.

Also, please ensure that you contact the doctor that will be managing the case at Riverview Animal Health Centre to ensure continuity of care.

REFERRAL POLICY

We kindly request that you follow these steps when referring a patient to Riverview Animal Health Centre to ensure we provide the best possible care, quickly and efficiently.

Emergency Referrals - If your patient requires immediate medical care within 24 hours, please call the hospital at 506-387-4015 to talk directly to our Emergency Doctor team.
Please complete the Patient Referral Form below and attach all pertinent Medical Records.
Non-Emergent Referrals - Please complete the Patient Referral Form below and attach all pertinent Medical Records. One of our team members will contact the client to schedule an appointment with the appropriate department. Our Doctor Team will contact you directly should they require further information.
As a reminder, all recheck appointments and medication refills are required to go to their referring veterinary hospital, except for orthopedics which will be followed until case completion. Medical records will be sent back to your hospital with notes on timelines for rechecks.

Thank you for your referral. We appreciate your continued confidence in the services that we provide.

Which doctor are you referring your patient to?

REFERRING VETERINARIAN INFORMATION

Name of Referring Veterinarian *

Name of Referring Hospital *

Phone Number *

Cell Number

Email Address of Referring Veterinarian *

Best time to contact you

CLIENT INFORMATION

Client's Name *

Spouse / Co-guardian Name

Address *

City *

Province *

Postal Code

Phone Number*

PATIENT INFORMATION

Patient's Name *

Date of Birth *

Species *

Breed *

Weight (in kg) *

Colour *

Sex (Spayed/Neutered) *

Reason for Referral *

Emergency / Hospitalization / Critical Care (please call our emergency team for referral)
Medical Procedure (i.e. CT Scan, Ultrasound, Endoscopy, etc.)

Please note one of the following 2 timelines: A team member at Riverview Animal Health Centre will call the client to set up appointments for Next Available and Urgent / Emergency requests.

Select Timeline *

Next Available - Patient is stable and can have procedure/appointment within the next 2 weeks.
Urgent / Emergency - Communication has been made with the RAHC team and patient is on the way.

Pertinent Medical History (including Current Diagnostics/Treatments/Medications) *

Please send medical records, including Radiographs.

Patient's Medical Records

Preferred Communication *

I would like a call from the Doctor.
Please book the appointment with the client.

Security Question *

I HAVE READ AND UNDERSTOOD THE PRIVACY POLICY *

Patient Referral Form

REFERRAL POLICY

REFERRING VETERINARIAN INFORMATION

CLIENT INFORMATION

PATIENT INFORMATION

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