Prescott Animal Hospital Large Animal Surgery & Medical Referral Centre a division of Leeds-Grenville Veterinary Professional Corp



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Prescott Animal Hospital

Large Animal Surgery & Medical Referral Centre

A division of Leeds-Grenville Veterinary Professional Corp.
RR# 4

2725 Edward St. N.

Prescott, Ontario, K0E 1T0

laclinic@prescottvet.ca

www.prescottvet.ca

Telephone (613) 925-4200

Fax (613) 925-5900
Referral and Emergency Transfers

Referring Hospital__________________________________ Referring DVM_____________________________

Clinic Email________________________________________ Clinic Phone #_____________________________

Client Information Patient Information
Name_________________________________ Name____________________________________________

Address________________________________ Breed____________________________________________

Address_______________________________ Date of Birth______________________________________

Phone #_______________________________ Color_____________________________________________

Email__________________________________ Sex M /F / MN (Circle one)

Last Tetanus Vaccine______________________________


Included Relevant Documents
Medical Records □ Radiographs □ Bloodwork □ Other □ Food□


Presenting Complaint_______________________________________________________________________________
Current/Relevant History__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Current Treatments & Medications

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________



Please indicate your preferred method of communication so we may update you on the status of your patient

□ Phone_____________ □Text_______________ □Fax_________________ □Email___________________________________



□Time_____________________________________

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