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24/7 Emergency
(802) 863-2387

Specialist Referral Form

Please review our referral instructions and call us at (802) 863-2387 to submit a referral. Once you have called in your referral, you may complete and submit the below online referral form and attach patient records and radiographs as needed.

If you prefer, you may email patient records and radiographs to info@bevsvt.com or mail to 1417 Marshall Avenue, Williston, VT 05495.

 

    Referring Veterinarian's Information

    Referring Veterinarian's Name:

    Referring Veterinarian's Phone:

    Hospital Name:

    Client's Information

    Client's Name:

    Client Phone/s:

    Home Phone:

    Work Phone:

    Cell Phone:

    Client's Address:

    Client's E-mail Address:

    Patient's Information

    Name:

    Breed:

    Age:

    Sex:

    Spayed/Neutered:

    Weight: lbs

    Patient's History

    Client Complaint/History:

    Clinical Problem/s:

    Laboratory and/or Radiograph Results:

    Medications:

    Attachement a file:

    You may call and speak with one of our specialists to discuss a case Monday through Friday 8:00am–5:00pm. Our doctors will communicate with you throughout your patient’s treatment process to assist you in providing appropriate follow-up care. All medical records and test results will be sent to you within 24 hours of the patient’s discharge.
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