The Veterinary Medical Center of Central New York accepts clients on emergency and referral basis only. No routine veterinary care will be provided unless specifically authorized by the referring hospital.
Referring Hospital
*
Phone
*
Referring Veterinarian
*
Practice Email
*
Email
*
Phone
*
Pet Name
*
Age/DOB
Weight
Species
*
Breed
Sex
*
- Please Select - M F M/C F/S
List last vaccinations given and dates
Current Medications (Dose, Route, Response)
Case Summary: “See attached records” will not be accepted for the chief complaint or the history. Please provide a short chronological case summary relevant to the reason for referral (onset of problem, summary of diagnostic testing done, summary of treatments/medications attempted and response to treatment, etc.) Please also provide any non-related pertinent medical diagnoses (such as history of trauma, history of surgery, anesthetic complications, or current co-morbidities (i.e.; diabetes, genetic abnormalities, bleeding disorders, etc.).
*
Duration of clinical signs:
*
Patient behavior: *All Aggressive pets must come in for consultation on sedation medications (such as Gabapentin and Trazodone) or we will be unable to see them for the appointment* Please consider sedation for anxious pets as well.
*
History, PE, and Clinical Findings
Thank you for this referral and your ongoing support! Please feel free to contact us at any time.
If you are human, leave this field blank.
