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Online Referral Form

Save time during your next appointment! Complete your required forms online from any device at any time before your visit.

Online Referral Form

Please fill out the form as completely and accurately as possible so we can get to know your patient prior to the appointment.  If this is an emergency, or if your pet needs urgent care, please call us at 434-202-2987 for a faster response. This form is to be filled out by the referring DVM.

If you choose to download and print the form, you can fax to 434-260-3822 or scan and email to

Department for Referral

If you are referring to our oncology department, click here.

Patient's Information

Vaccination Status


Upload Patient's Information Below

Click or drag a file to this area to upload.
Click or drag files to this area to upload. You can upload up to 6 files.