Referral Form for Veterinarians

Please complete this referral form to summarize previous case history and findings. The pertinent records and diagnostics test results can be attached to this referral or can be sent to us by email or fax. Clients can also bring them at the time of their appointment.

Download printable form

Type of Referral

Clinic Mobile

Referring Veterinarian Information

Client & Pet Information

Male Intact Male Neutered Female Intact Female Spayed

Other Medical Records

Chemistry Urinalysis T4 Rabies vaccination date

proBNP Thoracic Radiographs CBC Heartworm test date and result

Positive Negative

+Add Attachment

Pertinent records, diagnostics test results etc.

Submit

What We Do
For Veterinarians
For Pet Owners

vhc@vetheartcare.com
Phone: (757) 605-1610

Veterinary Heart Care
Dr. Herbert W. Maisenbacher III,
VMD, DACVIM (Cardiology)

Get in touch

Call us at (757) 605-1610 or fill out the form and we’ll get back to you soon

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COVID-19 Update

In order to limit the human health effects of the coronavirus pandemic, we are following all federal and state guidelines and recommendations. We continue to see both mobile consultations and referral appointments, but we are taking extra precautions to protect you, veterinary staff, and our community when we see your pet. If you have questions, please call to ask about our updated COVID-19 precautions and what to expect at your visit.