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Pet Emergency?

Please contact your preferred animal emergency hospital.

Veterinary Emergency Group – Cary
(984)345-3033 – Doctor available 24/7
2030 Kildaire Farm Rd
Cary, NC 27518

Online Form

DVM Referral Form

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DVM Referral Form

Please note that fields marked with a red asterisk (*) are required for form completion.

Referring Veterinarian

Referral Date(Required)

MM slash DD slash YYYY

Doctor Name(Required)

First Last

Hospital/Clinic(Required)

Referring Doctor Email(Required)

Hospital/Clinic Phone(Required)

Referral urgency(Required)

Urgent

Not Urgent

Referral for(Required)

Surgery

Client

Client Name(Required)

First Last

Phone

Client Email(Required)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Patient

Name(Required)

Date of Birth or Age (years & months)

Breed(Required)

Color(Required)

Weight(Required)

Sex(Required)

Male

Neutered male

Female

Spayed female

Unknown

Date most recent rabies vaccine was given:(Required)

MM slash DD slash YYYY

Duration of rabies vaccine:(Required)

1 Year

3 Year

Temperament Notes

Current medications & supplements - please include dosage(s)

Referral Information

Clinical Diagnosis(Required)

History & supporting information (please include with this referral copies of any diagnostics, including lab work, radiographs, ultrasound, etc.)(Required)

File Upload - diagnostics, lab work, radiographs, ultrasound

Max. file size: 50 MB.

Please indicate below the diagnostics and imaging accompanying this referral:

Laboratory: CBC, Chemistry, hormonal testing

Histopathology, cytology

Culture & sensitivity

Stone analysis

Radiographs

Fluoroscopy

Ultrasound

MRI

Joint Arthroscopy

Other

Please specify:(Required)

Please ask the client to call for an appointment. 919-545-1001. Our hours of operation are Monday-Friday 7:30 a.m. to 5:30 p.m. Thank you for your referral.

Name

This field is for validation purposes and should be left unchanged.

Why they chose us

“We were so excited that your surgeons offer the choice of an indoor or outdoor exam. Our pet is much more relaxed and less anxious in your outdoor exam room.”

-Allison H.

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