Emergency Referral Form

To refer a patient to the emergency service at Arkansas Veterinary Emergency & Specialists, please submit the form below.

PLEASE NOTE: This form is for emergency referrals only. For specialist referrals, click here

Referring Clinic / Doctor

Clinic Name *

Doctor Name *

Email Address *

Phone Number for Consultation *

Consultation Details *

Pet Owner Information

First Name *

Last Name *

Phone *

Address *

City *

State *

Zip Code *

Patient Information

Pet Name *

Age / Date of Birth *

Species *

Breed *

Sex *

Weight (lb/kg) *

Emergency Information

Presenting Complaint *

Diagnosis / Differentials *

Current Medications, Labratory Findings, Recent Surgery, Other. Please include the time medicine was last given or when treatments were complete. Send radiographs and copy of blood work with owner. *

Instructions for Emergency Doctor. Please include medication doses, route of administration, fluid type and rate. *

Upload any relevant documents

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Next Steps (Please check all that apply) *

Bill us for client charges

Patient is to return to my hospital for continued care

Please keep patient for workup

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From Our Clients

"I’ve been to AVES on three separate occasions for my fur babies. I also took my granddaughter and granddog there and I took a friend's cat there. They have always been compassionate and taken care of the fur babies I brought to them. Highly recommend!"
Sandra P.