Veterinary Care Center of SLO

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Internal Medicine Referral Form

(This form is for Partner Veterinary Hospitals only)

To become a partner hospital please email us at vetcarecenterofslo@gmail.com to get more information

Please fill out the form below and click the submit referral button

For Veterinarians Only

Choose an option

Name of Referring Veterinarian

Veterinarian's Email for Reports

Veterinarian's Phone Number

Client's First Name

Client's Last Name

Client Email

Client Phone Number

Patient's Name

Patient's Breed

Patient's Weight (kg)

Patient Birthday * required

Patient Information * Required

Canine

Feline

Male

Female

Spayed/Neutered

Requested Service * Required

Abdominal Ultrasound- Only

Abdominal Ultrasound and Internal Medicine Report

Endoscopy - Upper GI

Endoscopy - Upper and Lower GI

Add On Services

In Person Client Consultation - Add On

Cystocentesis - Add On

Centesis - Simple - Add On

Centesis - Advanced - Add On

Primary reason for consultation/scan

Please list current critical signs:

Please list abnormal laboratory results:

Current Medications: (especially steriods or anti-epileptic drugs)

Please list any pre-existing conditions:

Have Aspirates been authorized by the client? *

Yes

Any History of major abdominal surgery? *

Yes

Other critical or important information we should know:

Mail

Please Email Patient Records to: vetcarecenterofslo@gmail.com

Choose your Date: * Required

September 15, 2025

October 2025 -TBD

Thanks for submitting!

Once the appointment is confirmed with your client, you will receive an email

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