Ophthalmology Referral Form

*Indicates required fields

Please contact Capital City Specialty & Emergency Animal Hospital at (613) 244-7387 if you need assistance with any referral.

If the attachments surpass the maximum 50MB file size, please email the patient’s records and imaging directly to eyes@capcityvet.com.

a dog walking on a ledge

REFERRAL DETAILS

0 of 5000 max characters
0 of 5000 max characters

REFERRING VETERINARIAN INFORMATION

CLIENT INFORMATION

PATIENT INFORMATION

FILES

Please include all documents which are relevant to the presenting complaint here.

The following files are attached:

Max. file size: 50 MB.
Max. file size: 50 MB.
Max. file size: 50 MB.
Max. file size: 50 MB.