Referralsin McKinney, Texas Client Name* Patient Name* Species* Breed* Choose Below*MaleFemaleNeutered Age of Pet* Color* Weight* Presenting Complaint and History*Presenting Complaint and History Initial T(Fc)* Initial Pulse* Initial Resp* Initial Pressure* Initial Time* Last T(Fc)* Last Pulse* Last Resp* Last Pressure* Last Time* Diagnostics PerformedBloodworkRadsUltrasoundFecalUrinalysisHeartworm OccultFeline Vera Other, please list Outside labwork pending, please list Lab submitted to PLEASE EMAIL COPY OF ALL LABWORK, RECORDS, AND ANY RADIOGRAPHS Surgical Procedures Performed Diagnosis/Differential Medications Administered (Time/Medication/Concentration/Amount/Route), please listMedications Administered IV Cath (Size/Placement/Time of Placement) Fluids Administered (Type/Total Volume Infused/Rate) Suggestions/Conversations with Owner regarding case, treatment, prognosis, course of therapy, limitation and/or personal concernsSuggestions PLEASE COMPLETE AND EMAIL THIS FORM FOR EVERY REFERRAL Date* Time* Referring Clinic* Would you like us to contact you if the patient’s condition changes?*YesNo Contact Phone Hours Please do not give an estimate for treatment of patient at MEVC We may try to contact you regarding case if more information is needed, or to confer with you. Thank you for your cooperation in helping us provide care for your patients and clients. Currently Having A Pet Emergency?Call Us Now! 469-820-0233 If your pet experiences an after-hours emergency, every second counts. Please contact our emergency clinic right away!