I am excited to partner together.

Fill out the veterinarian referral form to begin the process.

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VETERINARIAN REFERRAL FORM

This form is for veterinary professionals. If you are a pet parent, please either visit this page for more info or start the appointment booking process by filling out the client intake form.

Veterinary Referral Form

Veterinarian Name*

Clinic Name*

Clinic Email (After-visit summaries will be sent to this email address)*

Clinic Phone*

Client First Name*

Client Last Name

Client Email (Client intake form will be sent to this email address.)*

Client Street Address Line 1*

Client Street Address Line 2

Client City*

Patient Name

Expiration date of most recent rabies vaccine*

Diagnosis / referral reason*

Other medical issues

Current medications

Any other relevant information

Would you like to receive HHHVS information to hand out to your other clients?

Business Cards

Brochures

If possible, please upload the patient’s veterinary records here.

Upload File

Free Text

Thank you so much for your referral. Please reach out if you have any questions.

Providing pets with premium Integrative Veterinary Medicine in a loving and thoughtful way so they can live healthy happy lives.

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