Dermatology Referral Form

Handwritten or faxed referrals are no longer accepted. In order to provide the best care possible for patients, as well as timely and accurate communications, we ask that all referrals be done online, through our website. This helps us to eliminate incorrect interpretation of handwriting and illegible faxed documents. We look forward to supporting you in all of your veterinary dermatologic needs.

Thank you for your co-operation.
The Dermatology Team.

Client Information

*** We will contact your client directly. Appointments are not booked until a referral has been received. ***

Veterinary Clinic Information

Important Information

  1. Do not bathe your pet for at least 5 days prior to your appointment and do not feed you pet for at least 12 hours to your appointment (UNLESS OTHERWISE SPECIFIED BY YOUR VETERINARIAN).

  2. Please note that pets referred to our facility can only be treated for skin related disorders. All other unrelated treatment or procedures willl be conducted by your family veterinarian.

Relevant Medical History

Dermatology History

Oral Sedation

If yes, please specify the medication(s) strength and dosage that you prescribed for their Dermatology consultation:

Oral Sedation Medication

Therapeutic History

Please include previous veterinary diets and topical treatments including shampoo, sprays, mousse and ear treatments.
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Diagnostic Tests

Please enclose ONLY pertinent dermatologic history
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Important Information

At VADER Clinic, we practice Fear Free Techniques to provide the best care with minimal stress for our patients.  In keeping with our Fear Free approach, we ask that you prescribe Gabapentin for all feline patients referred to us for a consultation.  Please have clients administer the Gabapentin at least 90 minutes prior to their appointment time.  Thank you.

Thank you! Your submission has been received!
At VADER Clinic, we practice Fear Free Techniques to provide the best care with minimal stress for our patients.  In keeping with our Fear Free approach, we ask that you prescribe Gabapentin for all feline patients referred to us for a consultation.  Please have clients administer the Gabapentin at least 90 minutes prior to their appointment time.  Thank you.
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