Mon – Sat: 7:30AM – 6:00PM
Sun: Closed

Clinic Referral Form

Refer Pets To The Pet Stop

Thank you for trusting your patients and clients with The Pet Stop’s dedicated team. Please fill out this form to the best of your ability and upload any medical records, diagnostic images, or lab results.

This form should only be filled out by a licensed Doctor of Veterinary Medicine or a Veterinary Hospital team member under the direction of a licensed Doctor of Veterinary Medicine.

Comments

This field is for validation purposes and should be left unchanged.

Reason for Referral

Chief Complaint/Reason for Referral(Required)

Referring Partner Information

Referring Doctor Name(Required)

First Last

Referring Clinic Name(Required)

Please don't use abbreviations.

Preferred contact method regarding medical updates:(Required)

Email(Required)

Phone(Required)

Fax Number

Client and Patient Information

Primary Client's Name(Required)

First Last

Secondary Client's Name:

First Last

Best Client Phone Number(Required)

Secondary Client Phone Number

Client Email

Pet Name(Required)

Age or D.O.B.(Required)

Sex(Required)

Select a Species(Required)

Dog

Cat

Unfortunately at this time we do not treat exotics.

Dog Breed(Required)

If breed is not listed, select "Mix" to write in patients breed.

Brief Medical HX(Required)

I am sending the medical records/diagnostics/etc. by:(Required)

Via Upload

Via Email

Via fax

To best take care of your patients and your clients please send all medical records including DVM notes, diagnostics performed/pending and results, as well as any imaging along with any radiologist report.

Attach a File(Required)

Drop files here or

Max. file size: 128 MB.

Our
App

Our
App

Clinic Referral Form

Refer Pets To The Pet Stop

Referring Partner Information

Client and Patient Information

Send Us a Message

Services

Client Resources

Support