top of page
iStock-2042747308 copy.jpg

Referral Form

Working together for the best care - refer your patient quickly and easily using the form below.

REFERRING HOSPITAL INFORMATION

Has this patient been seen at any other veterinary hospitals/clinics in the last 2 years?
No
Yes

CLIENT INFORMATION

(only needs to be completed if we will be contacting the client)

PATIENT INFORMATION

Sex

VETERINARY HISTORY

(Please provide as detailed of a summary as possible. Deferral to medical records may result in a delay of the referral process.)

Patient should be seen
Next available appointment
Priority appointment (if available)
Emergency (please call)

ADDITIONAL INFORMATION

If additional testing is recommended, can it be performed at Macleod Trail Animal Hospital without first contacting you?
Yes
No
If Dr. Jones feels this case would benefit from referral to another specialist, can this be offered to the client without contacting you prior?
Yes
No

MEDICAL RECORDS

Please indicate how you are sending the following:

Medical Records
Lab Results
Radiographs
iStock-2213567978 copy.jpg

Questions about the referral process?
Call us at 403-255-1168

bottom of page