Referral Form

Being trusted by another veterinarian is a privilege; one we take very seriously. We want to be your partner in healthcare and expand the capabilities veterinarians can offer their patients in Yuma. Our team will work with you to ensure your patients have access to the best technologies like CT, Endoscopy and Ultrasound, and always receive the highest standard of care.

We will also preserve your unique client/patient relationship. Referring veterinarians may use the online form below or contact our office for the appropriate fax or email document. Once we receive your referral form, we will reply within 24 hours. If you need more immediate assistance or have questions about our services or procedures, please call 928-342-0448.

Referring Hospital Information

Can we contact you after hours if we need more info or if the patient worsens?
After hours contact name and phone number:

Referral Department

Relevant Documents

Client Information

Patient Information

Diagnostics Performed

Labwork:
X-Rays:

Treatments/Meds Provided (dose, route, and times administered)

Brief overview of anything discussed with client (cost, prognosis, etc)

Type of Transfer:

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