Online Forms:
Rehabilitation Referral Form

DVM PATIENT REFERRAL

Thank you for your referral to Healing Hands Veterinary Hospital. We want this process to be convenient and efficient for DVMs, so we have created this easy online form submission.

Fields marked with an * are required.

1. Once this form is submitted, we will contact the pet owner directly to schedule their consultation.

2. After you complete this form, please email the patients radiographs, operative reports, medical history/notes, and any other pertinent information to info@healinghands.vet

3. Please note that all patients will be required to be up to date on their Rabies vaccination for appointments.

Owner's Name *

First

Last

Pet's Name *

Phone *

Email *

Referring Veterinarian: *

Referring Veterinarian Phone *

Referring Veterinarian Email *

The patient is referred to for: (check all that apply) *

Rehabilitation
Fitness/Conditioning
Acupuncture

Diagnosis:

Precautions/Special considerations: *

In accordance with the Texas Veterinary Board Rules, as the referring Veterinarian, I have established a valid veterinarian /client/ patient relationship and determined that rehabilitation will not likely be harmful to the patient. *

Clear Signature

Please sign

Date *

Today's Date

**Please provide radiographs, operative reports, medical history /notes, and any other pertinent information via email to info@healinghands.vet **

Thank you for this referral!

Please do not hesitate to call (210)372-9955 with any questions or concerns.

Online Forms:
Rehabilitation Referral Form

DVM PATIENT REFERRAL

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Address

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Hours

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We proudly serve the pets of San Antonio, TX and beyond.

Online Forms:Rehabilitation Referral Form

DVM PATIENT REFERRAL

Online Forms:
Rehabilitation Referral Form