UNIVERSITY OF CALIFORNIA, DAVIS
VETERINARY MEDICAL TEACHING HOSPITAL
PATIENT REFERRAL

 
Date:
This will introduce my client:
and patient named:
Referred by Dr:
Address:
City:
Phone Number:


Please indicate the level of communication you prefer on this case:

Written case summary is sent to all referring veterinarians within 10 days of discharge.
Phone call within 24 hours of arrival.

Phone call when significant event occurs, i.e., a diagnosis is made, patient condition changes, etc.
Communication by fax is acceptable. My fax number is_______________________
Communication by e-mail is acceptable. My e-mail address is__________________

Case history including duration of illness, signs observed, laboratory results, radiographic results (include radiographs), surgical/medical treatment received, immunizations diet, etc.
 
 
 
 
 
 
 

 Suggestions and comments by Referring Veterinarians:
 
 
 
 
 

 Please call one of the following numbers for an appointment:
 
Small Animal Clinic: (530) 752-1393 Large Animal Clinic: (530) 752-0290