Referrals

in McKinney, Texas

Client Name*

Patient Name*

Species*

Breed*

Choose Below*MaleFemaleNeutered

Age of Pet*

Color*

Weight*

Presenting Complaint and History*

Initial T(Fc)*

Initial Pulse*

Initial Resp*

Initial Pressure*

Initial Time*

Last T(Fc)*

Last Pulse*

Last Resp*

Last Pressure*

Last Time*

Other, please list

Outside labwork pending, please list

Lab submitted to

PLEASE EMAIL COPY OF ALL LABWORK, RECORDS, AND ANY RADIOGRAPHS

Surgical Procedures Performed

Diagnosis/Differential

Medications Administered (Time/Medication/Concentration/Amount/Route), please list

IV Cath (Size/Placement/Time of Placement)

Fluids Administered (Type/Total Volume Infused/Rate)

Suggestions/Conversations with Owner regarding case, treatment, prognosis, course of therapy, limitation and/or personal concerns

PLEASE COMPLETE AND EMAIL THIS FORM FOR EVERY REFERRAL

Date*

Time*

Referring Clinic*

Would you like us to contact you if the patient’s condition changes?*YesNo

Contact

Phone

Hours

Please do not give an estimate for treatment of patient at MEVC

We may try to contact you regarding case if more information is needed, or to confer with you.
Thank you for your cooperation in helping us provide care for your patients and clients.

Currently Having A Pet Emergency?

Call Us Now! 469-820-0233

If your pet experiences an after-hours emergency, every second counts. Please contact our emergency clinic right away!

Referrals

in McKinney, Texas

Please do not give an estimate for treatment of patient at MEVC

Currently Having A Pet Emergency?

Call Us Now! 469-820-0233

Call Now!

469-820-0233

Our Address

Hours

Service Areas