Online Form for RDVM Referrals

This form is for veterinarians who want to refer a patient to the Veterinary Emergency Referral Center.

The Veterinary Emergency Referral Center provides a wide range of emergency care, critical care, surgery and veterinary specialty services. Our board-certified veterinarians see animal patients in need of Neurology, Dermatology and Ophthalmology services. If you are a veterinarian who would like to refer a patient to our center, please fill out the form below with all available information.

Step 1 of 4

  • Please enter the referring Veterinary Doctor's name.
  • Please provide the referring Veterinary Hospital name.
  • Please provide the referring veterinarian's phone number.
    Please let us know if this is for a routine or urgent referral to VERC.

Additional Forms

To submit additional patient information, please download and fill out the following forms:

VERC Client Medication Acquisition Form VERC Dermatology Skin and Ear History Form