Referral Form of Animotion Animal Rehabilitation Center

We consider our facility to be an extension of your practice. All pets are seen for their referred problem only. Please note that routine veterinary care is not offered or performed. We take very seriously the importance of having your trust and confidence not only for the care and treatment we provide but also in honoring our professional relationship.

Upon arrival, the therapist will review your records, take a complete history of the patient and perform a detailed examination. These steps become the basis for the patient’s treatment plan.

Communication with you includes a comprehensive assessment and updates as the therapy/treatment progresses.

Upon completion of the treatment plan, a detailed synopsis is provided to you for your review and for your records.

Our doctors, therapists and support staff thank you for allowing us the opportunity to be a part of the care you provide your clients.

Referral Form

Please fill out the form below and we will get back to you as soon as possible. You can also download, print, and fax us your form by clicking here.

Veterinarian Information

Veterinarian:

Hospital:

Phone:

Fax:

Email Address

Receiving the Meds

Client Information

Client Name:

Address:

City / State / Zip Code:

Home Phone:

Mobile Phone:

Prior to appointment, please fax referral form with relavant records and laboratory results to: (781) 341-1915
Alternatively, you may also email all information to: animotion@lloydanimal.com

Patient Information & History

Patient Name:

Species:

Breed:

Gender:

Age:

Diagnostics / Cheif Complaint

Significant History / Treatments / Concurrent Medications & Dosages

Rehabilitation Goals or Indications:

Completion of this form authorizes Animotion Animal Rehabilitation Center to evaluate and treat the above referred patient. As the Referring Veterinarian, I understand that I remain the primary care provider. Clients seeking any other services will be redirected to the Referring Veterinarian.

Veterinarian E-Signature

Date:

Veterinarians

Referring Veterinarians

What We Do

Referral Form

Veterinarian Information

Client Information

Patient Information & History