24/7/365 Emergency Care

Specialty Services by Appointment

210 Fullerton Avenue Whitehall, PA 18052

Call Today 610.435.1553

Referral Form

For your convenience, please download the vet referral form or fill out the form below.

Veterinary Referral Form

Clinical Pathology Lab Form

What services are you looking for?

Acupuncture & Alternative Therapies Behavioral Therapy Cardiology Clinical Pathology CT Imaging and Fluoroscopy Emergency Medicine Internal Medicine Hyperbaric Oxygen Therapy Pet Loss and Bereavement Support Radioiodine (I-131) Oncology Ophthalmology Surgery

Referring Veterinarian Information

Name *

Hospital*

Address

City

Zip

Phone*

Email*

Owner & Pet Information

Client Name*

Pet Name*

Species*

Age*

Breed*

What is your reason for referral?*

What is your pets' history?*

Diagnostics*

What treatments and medications have been given to the pet?*

Enclosures

(Simply indicate what you plan on forwarding) (if any)

Lab Reports Radiographs Other

Please use the upload option if you have documents to share. Acceptable formats: pdf and zip

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