URGENT NOTICE: Our ER is experiencing a high volume of cases. Please call ahead so we can talk you through your pet’s situation and prepare for your arrival.

FOR VETS- Emergency Referral Form

Complete your required form online from any device at any time before your visit that way we know what to expect on your arrival.

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Online Forms

Please fill out this form as completely and accurately as possible so we can get to know more about the pet prior to arrival.

Transferring Clinic Name *

Hospital Address *

Address Line 1

Address Line 2

City

State

Zip Code

Hospital Phone Number *

Hospital Fax Number

Hospital Email

Referring Veterinarian *

First

Last

Client Name *

First

Last

Client Address *

Address Line 1

Address Line 2

City

State

Zip Code

Client Phone Number *

Pet Information

Name *

Breed *

Species *

Sex *

Male
Neutered Male
Female
Neutered Female

Color *

Date of Birth *

Reason for transfer (include any recent surgical procedures, treatments, and diagnoses)

Medications given or medications patient is currently prescribed (please include name, dose, frequency, route, concentration, and the time and date of the last dose of each medication given, if applicable

Has the patient had bloodwork, x-ray's, or ultrasound recently (related to the case)? Please email villagevethamburg@gmail.com any diagnostic testing related to this case or send results with the client at time of discharge.

Has the patient had bloodwork, x-ray's, or ultrasound recently (related to the case)? Please email (villagevethamburg@gmail.com) any diagnostic testing related to this case or send results with the client at time of discharge.

Referring veterinarian treatment plan

If the pet's condition alters, changes in the treatment will be made in the best interest of the pet. The owner will be notified of any changes, and a follow-up to the referring veterinarian will be made after the pet is discharged.

Thank you for your confidence in us. Patient status updates will be forwarded.

FOR VETS- Emergency Referral Form

Online Forms

Pet Information

Our Contact Information!

Location

Contact Information

Hours

We're here for you!Please complete the form below, and a member of our team will get back to you as quickly as possible.

We're here for you!Please complete the form below, and a member of our team will get back to you as quickly as possible.