Referral Process

Our Professional Promise to You

Uncompromised excellence is the core of the referral service at Animal Medical and Surgical Center. All referring veterinarians receive a detailed report describing every aspect of treatment, diagnosis, and medical or surgical procedure. This may include a DVD of the surgery in some cases.

It is our policy to treat referred patients only for the specific procedure for which they were referred and we will not provide any veterinary care other than what their primary doctor has requested unless complications dictate otherwise. We value the professional relationship we have with our referring veterinarians and we are available to answer any questions.

For more information about referrals to Animal Medical and Surgical Center, please contact us.

How to Refer a Patient

Download a printable referral form and fax it to us, or submit your referral request online.

Fax: 480-502-4416

Be sure to include medical records, diagnostic information, and any other pertinent case materials whether submitting by fax or online.

Please contact us at 480-389-3037 with any questions or specific requests.

Referral Forms

To refer a patient, you can complete and submit the online referral form you need, or you can download and complete the fill-able PDF document. If you choose to use our PDF forms, you can either submit the completed form through the Online Submission Form on this page, or print and bring it with you to our hospital.

Select the type of form you want to use below:

Referral Form - Web

Client*

Patient*

Tentative Diagnosis*

Therapy Requested*

Referring Veterinarian*

Phone*

CT Referral Form - Web

Referring Veterinarian Information
Date* Referring Doctor*
Referring Hospital* Hospital Phone*
Hospital Address
Client Information
Client* Client Phone*
Client Address
Patient Information
Patient Name* Species*
DOB Gender
Breed Weight
Tentative Diagnosis*
History
Clinical Symptoms
CT Images Requested
Please select all that apply, and specify segments or requests in the field below.
BrainSinusesAbdomenThorax
Cervical Spine (specify segment)Thoracolumbar Spine (specify segment)
Hip LeftHip RightStifle LeftStifle RightShoulder LeftShoulder Right
Elbow LeftElbow RightCarpus LeftCarpus Right
Other (please specify)
Specific segments or other notes:
Referral Agreement

It is the policy of Animal Medical and Surgical Center that we will treat your pet only for the specific procedure for which you were referred and cannot provide any veterinary care other than that requested by the primary veterinarian.

It would be considered a breech of the ethics of our profession to assume any pet’s veterinary care that would normally be provided by the veterinarian that has referred you to us.

I understand that my patient is being referred to Animal Medical and Surgical Center for CT Imaging only.

By submitting this form, I acknowledge that I have read and agree to the above referral policy of Animal Medical and Surgical Center.

Signature of Referring Veterinarian* Date*

PDF Referral Forms

If you would like to download the PDF, and do not already have AdobeReader® installed on your computer, click HERE to download.

Referral Form - PDF  CT Referral - PDF

Online Submission Form

Your Name (required)

Your Email (required)

Your Phone

1.) Complete necessary form(s)

2.) Save form(s) to computer/device

3.) Click "Choose File" below & attach your completed form

4.) Click "Send"

Questions? Speak with our referral contact!
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