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Referral Form

Name: Bedrock Veterinary Specialists
Address: 20801 Torrence Chapel Rd., Cornelius, NC, 28031, United States
Telephone: 980-580-7700
Price range: $

Thank you for trusting us with your patients!

Please note: This form should only be filled out by a veterinary team member. We will be in touch with you and your client shortly.

Clinic Name:(Required)

Clinic Phone Number:(Required)

Referring Veterinarian After-Hours Phone Number:

Primary Care DVM:(Required)

Clinic Email Address:(Required)

Client Name:(Required)

First Last

Client Phone Number:(Required)

Patient Name:

Species(Required)

Canine

Feline

Other

If other, please specify:(Required)

Type of Referral(Required)

Standard

Urgent (Please call our Admissions Department to initiate your urgent referral and provide case information below)

Patient demeanor?(Required)

Friendly

Caution

Requires Muzzle

Rabies vaccine up to date?(Required)

Yes

Is the patient up to date on other vaccines?(Required)

Yes

Blood work completed within the last 3 months?(Required)

Yes

Radiographs completed?(Required)

Yes

Any Heart Murmur?(Required)

Yes

Any health concerns we should know about before anesthesia or surgery?(Required)

Yes

If yes, please explain:(Required)

Summary of Doctor's Exams:(Required)

Relevant Medications (e.g., NSAIDs, steroids):(Required)

Upload Medical Record & Diagnostics:

Max. file size: 256 MB.

Date(Required)

MM slash DD slash YYYY

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Phone

This field is for validation purposes and should be left unchanged.

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Our Location

20801 Torrence Chapel Rd.
Cornelius, NC 28031
Click here for directions

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Contact Us

P: 980-580-7700
E: contact@bedrockvet.com

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Hours

Regular Hours
Mon – Fri: 8:00 AM – 4:00 PM
Sat-Sun: CLOSED

Admission Services
Mon – Thu: 8:00 AM – 9:00 PM

Click here for our Special Hours

Special Hours

December 25th - We will be closed on Monday, December 25th for Christmas!

Have a question?

Complete the form below and we'll be in touch with you shortly.

Name *

First

Last

Email *

Phone

Veterinarian Phone

How can we help you? *

Info on CCL Tears