Request Referral

IN CASE OF AN EMERGENCY

When your patient is unstable and moments count, please call us at 604.473.4882 when the patient is on its way or speak to the doctor on duty in the ER + Critical Care Service. You can send the referral form as soon as reasonably practical after that.

The ER + Critical Care Service often manages emergencies, unstable or non-scheduled referral cases.

PLEASE NOTE

You can’t save the online form and continue later, so keep that in mind in case you can’t spare 5–10 minutes to fill out the entire form(s) in one go. If so, please submit by email or by fax instead.

Our referral form is also available as a fillable PDF.

PDFs can be emailed to [email protected] or faxed to 604.473.4898

Referral Details
Date of Referral*
MM slash DD slash YYYY
Request*
- Next available appointment
- Urgent
- Emergency
Referral to:*
Hold Cmd key (Mac) or Control key (Windows) to select/deselect multiple options.
Referring Veterinarian Information
Referring Hospital*
Veterinarian*
Phone (Daytime)*
Phone (After Hours)*
Fax
Email*
Client and Patient Information
Client First Name*
Client Last Name*
Address*
Street Address City Province Postal Code
Phone (primary)*
Phone (secondary)
Email*
Have owner or pet been here before?*
- Yes
- No
- Unknown
Patient Name*
Species*
Breed*
Age*
Weight*
Sex*
Estimated time of arrival if sending patient immediately*
Tentative Diagnosis / Chief Complaint
Tentative Diagnosis / Chief Complaint*
Please describe.
History / Physical Exam Findings
History / Physical Exam Findings*
Please describe.
Treatments (include medications and dosages)
Treatments (include medications and dosages)*
Please describe.
Laboratory Data Summary
Laboratory Data Summary
Please describe.
Select Laboratory Data Status*
Radiographs Summary
Radiographs Summary
Please describe.
Select Radiographs Status*
Special Requests / Comments
Special Requests / Comments*
Please describe.
Pet Vaccination Status
Rabies*
- Yes
- No
- Unknown
If yes, year
Other Vaccination
Year
Other Vaccination
Year
Other Vaccination
Year
Comments
This field is for validation purposes and should be left unchanged.

Referral Details

Referring Veterinarian Information

Client and Patient Information

Tentative Diagnosis / Chief Complaint

History / Physical Exam Findings

Treatments (include medications and dosages)

Laboratory Data Summary

Radiographs Summary

Special Requests / Comments

Pet Vaccination Status

Contact Us

Careers

EMERGENCY & CRITICAL CARE
- Any Emergency and Critical Care Professional
- Dr. Teresa Cheng
- Dr. Carsten Bandt
- Dr. Kirsty Royle
- Dr. Chris Drolet
- Dr. Annie Lin
- Dr. Andrea Henrikkson
- Dr. Pascale Laroche
INTERNAL MEDICINE
- Any Internal Medicine Professional
- Dr. Jefferson Manens
- Dr. Lauren Adelman
- Dr. Iris To
NEUROLOGY
- Any Neurology Professional
- Dr. Nick Sharp
- Dr. Rachel Lampe
- Dr Francesca Samarani
- Dr. Ruby Ng
ONCOLOGY
- Any Oncology Professional
- Dr. Tien Tien
RADIOLOGY
- Dr. Erin Keenihan
- Outpatient Abdominal Ultrasound
- Outpatient CT
- Outpatient Radiograph Review
SURGERY
- Any Surgery Professional
- Dr. Michael King
- Dr. Emma Hall
- Dr. Katja Lin