Is this an urgent referral? *

Yes
No

Reason for referral *

Referring Veterinary Practice *

Referring Veterinarians Name *

Client Name *

First

Last

Client Email *

Client Primary Phone Number *

Client's Home Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Patient Name *

Species *

Breed *

Sex *

Male
Neutered Male
Female
Spayed Female

Age *

Is the patient fractious? *

Yes
No

Oral Sedatives

All cats must be prescribed gabapentin and all dogs must be prescribed Trazodone +/- Gabapentin prior to their appointment.

General sedation recommendation guidelines:

As the referring veterinarian, it is your responsibility to determine the appropriate dose of sedation for your patient. Please follow the recommended dosing guidelines below:

Cats: 100 mg Gabapentin, the night before and morning of the appointment.
Dogs: Trazodone 3-5 mg/kg and/or Gabapentin 10 mg/kg, 1-2 hours before the appointment.

If the patient is experiencing severe bradycardia (HR <100bpm for cats or <50bpm for dogs) please reach out to us to confirm the appropriate dosing.

Have the oral sedative(s) been prescribed and explained to the owner? *

Yes
Not yet, but will be arranged

Is there anything additional we should know about this patient or this referral? Please specify below.

Please upload any medical records and relevant diagnostics: *

Drag & Drop Files, Choose Files to Upload You can upload up to 5 files.

Please ensure all client information is accurate, as this will allow our team to contact the client without delay.

Referring Veterinarians

Emergency Services

Cardiology Referral Form

Oral Sedatives

Veterinary Services

Contact Details