Request An Appointment

Referral Request

Complete the form below to submit a referral request. We will contact you within 48 hours to confirm a booking time and date. For urgent requests, please call us at (905) 818-1602.

Note: If you are a pet owner, please contact your veterinarian to schedule.

Referring Veterinarian

Clinic Name

Clinic Phone Number

Clinic Email

Patient Should Be Seen:

Next Available Appointment Priority Appointment (if available) Urgent (please call)

Type of Procedure Requested:

Client Name

Patient Name

Patient Weight (kg)

Date of Birth

Breed

Sex:

M MN F FS

Species:

Canine Feline

Presenting Complaint

Brief History

Relevant Bloodwork and Imaging Findings

Differential Diagnoses

Primary Question to be Answered?

Additional Concerns?