Submit a Patient Referral

Referral form preview

Online delivery is not yet enabled. Please text (757) 647-7744 for referrals and scheduling. Do not enter real patient information in this preview.

Fields marked * are required.

01 Referring veterinarian

Veterinarian name *Hospital name *Direct phone number *Hospital email *Fax number (optional)

A referral copy and submission confirmation will be emailed to the hospital email above. Check the address carefully before submitting.

02 Client and patient

Client / owner name *Client phone numberPatient name *Patient birthdate *Use the birthdate in the medical record for the ultrasound system.Species / animal type *

Weight (lb)Weight (kg)

Enter weight in either box; the other converts automatically, rounded to three decimal places.

Sex / reproductive status *

Male intactMale neuteredFemale intactFemale spayed

03 Referral detailsRequested serviceReason for referral / diagnostic questions *Relevant history and examination findingsCurrent medications

04 Attachments

PDF, JPG, or PNG. Up to 5 files per section; 10 MB total. Add document dates so VEDI can review the most recent information first.

Labwork

Records must be listed from newest information to oldest. Enter each document’s date.

Add labwork

No labwork attached.

Patient records

Records must be listed from newest information to oldest. Enter each document’s date.

Add patient records

No patient records attached.

Your referral details and attachments are sent to VEDI by email for case review and coordination. A copy is also emailed to the hospital address you enter. Submit only information you are authorized to share. Read the privacy notice.

I understand that this form is not monitored continuously and does not schedule an appointment. I will text VEDI directly for scheduling or urgent requests.

For scheduling, text (757) 647-7744.