Veterinarian Referral Form

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Veterinarian Referral Form

We know our best source for feedback is you. We encourage you to share your experience with us by taking this brief survey. Please be candid and specific. Your responses direct our approach in providing quality, compassionate veterinary care and pet owner support. We thank you for your time and trust in Monroe Veterinary Associates.

For upcoming dermatology consultation availability, please call (877) 604-8366.

Referring Veterinarian Data:

*Please attach or send copies of lab work and other tests results performed within past 2 weeks.

Client Information:

Patient Information:

Please list the dates of the last time client's pet has been vaccinated for the following: Distemper, FELV, HWT, Rabies
Please list all current drugs and dosages; indicate special diet needs
*All brain scan requests should be referred through the neurology service.

– (OUTPATIENT ULTRASOUND ONLY) This service is intended for stable outpatient examinations. You will receive a written faxed report of the ultrasound findings within 24-48 hours.

Ultrasound guided biopsies will not be performed for outpatient examinations. Consider referral to Internal Medicine for these cases.

Please communicate the following with the client prior to an ultrasound appointment:

  • Risk and cost to perform additional procedures
  • Follow-up plan: will you be calling the client upon receipt of report or would you like them to schedule a recheck with you to review results?
  • Please explain that the pet will be shaved and the importance of following instructions for fasting.
  • In the event that the patient arrives at Veterinary Specialists in an unstable condition, the patient will be assessed and stabilized by the emergency service prior to an ultrasound examination.

Thank You for Your Referral!