Rehabilitation Referral Form

We value the trusted relationships you’ve built with your clients and their pets. If you have a patient who may benefit from veterinary rehabilitation, we are here to help with science-based treatments and therapies.

Use the referral form below to share your patient’s history, diagnostics, and specific rehabilitation needs. Our team will work closely with you to develop a care plan that complements your treatment goals and supports the best possible outcomes.

We look forward to partnering with you to help pets move better, feel stronger, and live longer.

Thank you for giving our Animal Rehabilitation Center the opportunity to care for your patients. So that we may provide care with continuity, please complete the following referral information:

Primary Care Practice:(Required)

Primary Care DVM:(Required)

Best phone number to reach Referring Veterinarian:(Required)

Email for Collaboration:(Required)

Client's Name:(Required)

First Last

Email Address (for patient correspondence only):(Required)

Telephone Number:(Required)

Pet Registration

Patient's Name:(Required)
First

Species (Canine or Feline):(Required)

Birth Date:(Required)
MM slash DD slash YYYY

Sex:(Required)

Male, intact

Male Dog

Female, intact

Female Cat

Weight (lbs):(Required)

Are immunizations current?(Required)

Yes

No

Patient's history:(Required)

Tentative Diagnosis:(Required)

Current Treatment/Medications:(Required)

Please send all recent radiographs, pertinent medical history and blood work from the last six months with your client. Thank you for your confidence in this referral. Please Provide Medical Records Here:
Max. file size: 50 MB.

Please Attach Rediographs:
Max. file size: 50 MB.