Referring Veterinarians

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.

Referring Veterinarian

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

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
Treatments
Radiographic Findings
Radiographs will be sent
Please return films
Special Request/Comments

Download Forms

Referral Form

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

DOWNLOAD Referral Form