Form to be completed by veterinary staff only
Would you like us to contact your client to set up their initial assessment?
Up to date on core vaccines?
Condition(s) being referred for. Please include details and date of onset/treatment/surgery:
Important medical history (i.e. any history of neoplasia, diabetes mellitus, heart disease, seizures, etc.):
Were radiographs taken?
Current medications or supplements and dosages:
I, the referring veterinarian listed on this form hereby authorize the
Certified Canine Rehabilitation Practitioners and staff at Allandale
Veterinary Hospital to perform physical rehabilitation therapies with
the identified patient.
Allandale's Rehab Referral Patient Policy:
We fully respect the relationship pets and clients have with their
family veterinarians and out of a mutual respect to our surrounding
veterinary clinics we will not offer any routine veterinary care
(i.e. routine exams, vaccinations, medication prescriptions, etc.)
to your patients.
We look forward to working with you and your patient on their
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