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

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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

Spam Blocker

From Our Clients

"The staff were very nice and attentive. They walked us through every step while in the clinic. Even before the visit when I called, they were very informative and let me know what to expect. We arrived with my cat feeling unwell and acting out of character and left with a happy and healthy cat."
Mattie O.