Referrals

A Note to Referring Vets

Please fill out the form below and send copies of labs, radiographs, and other diagnostics you find relevant to bigrivervetacu@yahoo.com.

If you prefer, Download our Medical Release/Vet Referral as a pdf and email it to us at bigrivervetacu@yahoo.com.

Referring Veterinarian

First Name

Last Name

Veterinarian Address

Veterinarian Phone

(###)

###

####

Veterinarian Email

Client Name

First Name

Last Name

Patient Name

Client Address

Client Phone

(###)

###

####

Primary Reason for Referral

Patient Medical History

Diagnostics

Treatments/Medications

Goals/Expectations for your Patient

Follow Up Preferences

Medical Release

I, the referring veterinarian, have examined this patient within the last 30 days and have found [him/her] to be clinically ready for the treatments indicated below (check all which apply). I I understand the owner of this patient will schedule an appointment with BRVA within a month of my exam, and that if BRVA has any concerns, a recheck at my practice may be necessary.

Prehabilitation Prior to Surgery

Rehabilitation for a non-surgical patient

Weight Loss

Fitness Training

Referrals

Big River Veterinary Acupuncture and Rehabilitation