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Referring Veterinarian Communication Preference Form

At West Hills Animal Emergency & Critical Care Center, ongoing communication with you is very important to us. Communications are tailored to your individual preference. We believe that open communication with the primary vet is essential to providing clear managing of each patient’s case.

Please take the time to complete our referring Veterinarian communication preference form.

This form can also be downloaded here and faxed back to us at (631) 367-8130.

Practice Information

Practice Name:(Required)

Veterinarian #1 Name:(Required)

Prefix First Last

When clients are referred to our Critical Care Center, do you prefer? (Check all that apply)(Required)

Email Summary report - Email Address:

Faxed Summary Report:

Phone call - Best number:

Veterinarian #1 Email:

Veterinarian #1 Fax:

Veterinarian #1 Phone:

Veterinarian #2 Name:

Prefix First Last

Veterinarian #2 - When clients are referred to our Critical Care Center, do you prefer? (Check all that apply)

Email Summary report - Email Address:

Faxed Summary Report:

Phone call - Best number:

Veterinarian #2 Email:

Veterinarian #2 Fax:

Veterinarian #2 Phone:

Veterinarian #3 Name:

Prefix First Last

Veterinarian #3 - When clients are referred to our Critical Care Center, do you prefer? (Check all that apply)

Email Summary report - Email Address:

Faxed Summary Report:

Phone call - Best number:

Veterinarian #3 Email:

Veterinarian #3 Fax:

Veterinarian #3 Phone:

CAPTCHA

Referring Veterinarian Communication Preference Form

Practice Information

Pet emergencies for which you should immediately seek medical care: Symptoms include:

Links

Hospital Hours