Please have your client call our office to make an appointment. Feel free to contact us if you have any further questions or if we can assist you or your client in any other way. Thank you for your referral!
Referring Veterinarian Information*
DVM Name
(Required)
Hospital Name
(Required)
Phone
(Required)
Email
(Required)
Owner's Information*
Owner's Information
(Required)
Owner's Phone Number
(Required)
Patient Information
Pet Name
(Required)
Breed
(Required)
Age
(Required)
Weight
(Required)
Temperament
(Required)
Sex
(Required)
Male
Neutered Male
Female
Spayed Female
Affected Eyes
(Required)
Right Eye
Left Eye
Both Eyes
History of Eye Problems and Symptoms
(Required)
Other Systemic Health Concerns
Current Medications
Diagnostic Tests Performed & Results
(Required)
Urgency of Appointment:
(Required)
Emergency (Please call ahead or send all records before client calls; emergency fees will apply)
Urgent (10-15 business days)
Routine (Next available)
Upload Patient Records: If you are able, please upload relevant patient records and any recent labwork (within 6 months). It helps us to schedule your patients appropriately. Records may also be emailed to staff@peteyevet.com or faxed to 972-437-3938. Thank you!
Max. file size: 8 MB.