24/7 Emergency Vet Care • Speciality Services Monday - Thursday

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

Browse...

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

Spam Blocker

From Our Clients

"On a late Saturday night, I was able to find this emergency vet for my cat. It was horrible seeing her in pain and miserable. We were able to get in quickly, the staff was all very friendly and came to let me know what was going on throughout the visit. They were up front about costs and gave me estimates for treatment. I felt respected, I feel my cat was very well treated and cared for!"
Wendy O.