At Wildside Veterinary Health Center we make clear communication with referral veterinarians our top priority.

What should you expect?

• A notice that your patient scheduled an appointment with us will be sent to your email.
• Once your patient is discharged you will receive a full case summary.
• If you have any questions or concerns about the case you may contact us by email at contact@wildsidevet.com or call us during business hours (954) 681-5599.

What do you need to do?

1. Please fill the form below.
2. Send us all records and images (ex: of the patient’s lesions, of the radiographs, of the ultrasound, of the CT scan) to contact@wildsidevet.com – please put the patient’s first and last name as the email subject.
3. Ask the client to book an appointment.

Client's Name *

First

Last

Client's address *

(Street Address, City, State and Zip Code)

Referral Doctor Name *

First

Last

Referral Hospital Name *

Referral Doctor or Hospital Email *

Referral Doctor or Hospital Phone Number *

Patient's Name *

Patient's Species/Breed *

Patient's Age *

Patient's Last Weight (kg) *

Write n/a if you don't have this information

Patient's Sex *

• Male
• Female
• Unknown

Is the patient Neutered/Spayed? *

• Yes
• No
• Unknown

Pertinent Medical History *

Current medications (with the dose and frequency prescribed) *

Diagnostics performed *

• None
• CBC
• Chemistry
• Ultrasound
• Radiograph
• CT Scan
• MRI
• Histopathology
• Cytology
• Urinalysis
• Fecal exam
• Culture and sensitivity
• Other

Records and Images *

• I am forwarding all the pertinent medical records and images to contact@wildsidevet.com

Submit