Patient Referral
| Date: |
| This will introduce my client: |
| and patient named: |
| Referred by Dr: |
| Address: |
| City: |
| Phone Number: |
Please indicate the level of communication
you prefer on this case:
Phone
call when significant event occurs, i.e., a diagnosis is made, patient condition
changes, etc.
Communication
by fax is acceptable. My fax number is_______________________
Communication
by e-mail is acceptable. My e-mail address is__________________
Case history including duration of illness, signs observed, laboratory results, radiographic results (include radiographs), surgical/medical treatment received, immunizations diet, etc.
Suggestions and comments by Referring
Veterinarians:
Please call one of the following
numbers for an appointment:
Small Animal Clinic: (530) 752-1393 |
Large Animal Clinic: (530) 752-0290 |