Patient Transfer Referral Form If you are a veterinarian looking to refer a patient to Veterinary Medical Center of Central New York, please complete the Patient Transfer Referral form below, and contact us at (315) 446-7933 if you have any questions. Patient Transfer Referral Form Please Choose * Emergency Imaging Internal Medicine Oncology (please see separate referral form) Surgery 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 * Owner Name * Owner Name First First Last Last Email * Phone * Pet Name * Age/DOB Weight Species * Breed Sex * - Please Select -MFM/CF/S List last vaccinations given and dates Current Medications (Dose, Route, Response) Chief Complaint * History, PE, and Clinical Findings Are you requesting an ultrasound? - Please Select -YesNo If so, which area is to be studied? Abdomen Throax Are you sending radiographs? - Please Select -YesNo Please Upload Radiographs Drop a file here or click to upload Choose File Maximum file size: 52.43MB Are you sending lab results? - Please Select -YesNo Please Upload Results Drop a file here or click to upload Choose File Maximum file size: 52.43MB Upload any additional files Drop a file here or click to upload Choose File Maximum file size: 52.43MB Thank you for this referral and your ongoing support! Please feel free to contact us at any time. reCAPTCHA Submit If you are human, leave this field blank.
