Cornell University Veterinary Specialists 24 Hour Emergency and Critical Care

Referral Form

Please take a moment to complete the Patient Referral Form. Please Fax all records to 203.595.2778. Records may also be sent with the owner at the time of visit. For an appointment or to transfer a case, please call 203.595.2777. Thank you in advance for this information and for your trust in our care.

Patient Referral Form

Required Field*

Referring Doctor Information



How would you prefer to be contacted in this case?


Patient Information


Species/Breed/Sex/Age:

Patient referred to: (please check all that apply)



Presenting Complaint(s):

Case History: Please include when possible, duration of illness and clinical signs

Clinical Findings: Please include when possible, lab results, imaging findings (please send radiographs), any other diagnostic results

Current Treatment(s): Please include when possible, recent and current medications and doses

Specific comments, concerns of referring / primary care veterinarian:



Information

Cornell University Veterinary Specialists
880 Canal Street
Stamford, CT 06902
Phone 203.595.2777   Fax 203.595.2778

Directions

Map and directions

Emergency Hours

24 Hours a day, 7 days a week

Emergency & Critical Care Information

Specialty Hours

Monday - Friday

9am to 6pm

Weekend hours available by special appointment