Referral Forms — Triangle Veterinary Referral Hospital of Holly Springs . 919-973-5620

For Referring Veterinarians

You can download a printable copy of our referral form and fax the completed form to our Holly Springs hospital at 919-887-6911 or you can submit your referral or transfer using the online submission forms below.

If you complete an online referral form, please call our Holly Springs hospital at 919-973-5620 to inform us that you have submitted the form.

Printable Forms

Online Form

EMERGENCY REFERRALS

PLEASE DO NOT USE THIS FORM FOR EMERGENCY REFERRALS. INSTEAD CALL OUR OFFICE AT 919-973-5620 TO SPEAK DIRECTLY TO A CLINICIAN.

My patient does not need to be referred to the emergency department

Requested Service

Referring Veterinary Hospital

Referring Veterinarian

Hospital Phone Number

(###)

###

####

Client Name

First Name

Last Name

Pet's Name

Client Phone

(###)

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####

Species

Canine

Feline

Breed

Age

Sex

Presenting Complaint

Findings and Diagnostics

Current Medications

Additional Comments

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