Referring Veterinarians: Online Form for Requesting Pet Care Services

For your convenience, our referral forms can be completed and submitted on-line or there is an option to download the form and fax it to OVRS at (248) 334-3693. For consultations scheduled within the next 24 hours, please fax the referral form instead of the e-mail option.

To receive a copy of this form for your records, please make sure to complete the email field below.

Note for optional file attachments:
Individual file attachments must be less than 10MB. For large attachments, please be patient upon form submission, as the files may take a few minutes to upload. To upload multiple files for each section, please compress the files into a ZIP file.

Referring Veterinarian

Name
Hospital
Address
City
State/Province
Zip Code/Postal Code
Home Phone
Fax
Email

Client Information

Name
Address
City
State/Province
Zip Code/Postal Code
Home Phone
Business Phone

Patient Information

Patient Name
Species
Breed
Sex
Birthdate
Vaccination History
Tentative Diagnosis
History/Physical Findings
Laboratory Data Attach Laboratory Data File
Treatments
Radiographic Findings Attach Radiographic File
Radiographs will be sent
Please return films
Special Request/Comments Attach Additional File

Verification

Reset

Download Forms

Referral Form

The referral form must only be filled out by your veterinarian prior to your appointment.

DOWNLOAD Referral Form

Specialty Care for Special Pets

Emergency & Critical Care (248) 334-6877 - Open 24 hours You do not need a referral for emergency care

Referring Veterinarians

Referring Veterinarians: Online Form for Requesting Pet Care Services