For referring veterinarians - Jacksonville

Ir para o conteúdo

Call us 24h

915-400-1010

Locations

24/7 even weekends and holidays

Why GL?
Our hospital
For Vets
Blog
Work for us
Contact
Locations
FAQ
Payment Plans

Why GL?
Our hospital
For Vets
Blog
Work for us
Contact
Locations
FAQ
Payment Plans

Referral Form

Thank you for using our scheduling system! By scheduling stable patients in advance, we can better accommodate urgent cases that need immediate attention. We appreciate you filling out this form with accurate information—it helps us provide the best care for your patients.

Service Requested (you may select more than one) *

X-ray Only: The report will be sent to the referring DVM, who will communicate with the client and oversee continued care. Hospitalization & Continued Care: For patient transfers, please provide complete medical records.

Thorax Abdomen Skull Thoracic limb-region R(Right) Thoracic limb-region L(Left) Pelvic limb-region (Right) Pelvic limb-region (Left) Spine Other radiograph

Provide a detailed description of any specific issues:

rDVM Information

Referring Veterinarian Name*:

First Name

Last Name

Referring Veterinarian Clinic Name*:

Referring Veterinarian Email*:

Referring Veterinarian Preferred Phone Number*

Patient Information

Patient Name*:

First Name

Last Name

Species

Canine Feline

Breed*

Age/DOB*:

Sex*:

Male Female Male Neutered Female Spayed

Owner Name*:

First Name

Last Name

Owner Email*:

Owner Phone Number*:

Please provide comprehensive details (including medical history, physical examination, diagnostic tests, and laboratory results) for the patient:

Differential diagnosis:

Does the patient require sedation?

Yes No

Exam Performed (please provide images and copies of results along with medical records)

Upload of Medical Records

Is the patient currently on any medication?

Locations

(000) 000-0000

24/7 even weekends and holidays