Emergency Referral Form

Our emergency clinic is open 7 days a week. For life threatening veterinary emergencies please call our hospital at 520-795-9955 prior to completing this form. Our website is only monitored Monday- Friday from 9am - 5pm.

Referring Veterinarian Information

Hospital Name *

Veterinarian *

Phone *

Fax

Emergency Contact Number (if different from above)

What is your preferred contact method? *

Phone

Fax

Other

If Other, please specify:

Client Information

Owner's First Name *

Owner's Last Name *

Phone *

Pet's Name *

Breed *

Age / Date of Birth *

Sex *

Details of Emergency

Please provide details regarding the patient's emergency and the reason for your referral.

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Emergency Referral Form

Referring Veterinarian Information

Client Information

Details of Emergency

Emergency Care 7 Days a Week