Request Form - Primavet Animal Clinic

Service Request Form

Please note that this service is exclusively for external clinic requests. Our veterinarians will not provide consultations or direct communication with pet owners. Results will be issued to the referring veterinarian. Please fill out this service request form in its entirety to ensure we can provide your patients with the best service.

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Client/Patient Information

Client Name

Client Email

Phone

Patient Name

Pet Name

Patient Age

Pet Age in Years

a Patient Doctor

Species

Sex

Breed

(e.g., Labrador, Siamese, Mixed Breed)

Referral Information

Request DVM

Request DVM Email

Request DVM Practice

When requesting for service, please upload relevant medical records, diagnostics and images so our team can best support your clients and patients.

Click or drag a file to this area to upload.

pdf, doc, docx, xls, xlsx, csv, txt, rtf, html, zip, mp3, wma, mpg, flv, avi, jpg, jpeg, png, gif . Maximum each file 5MB.

File Upload

Click or drag a file to this area to upload.

pdf, doc, docx, xls, xlsx, csv, txt, rtf, html, zip, mp3, wma, mpg, flv, avi, jpg, jpeg, png, gif . Maximum each file 5MB.

File Upload

Click or drag a file to this area to upload.

pdf, doc, docx, xls, xlsx, csv, txt, rtf, html, zip, mp3, wma, mpg, flv, avi, jpg, jpeg, png, gif . Maximum each file 5MB.

If your files are too large to upload directly, you may share them via a Google Drive link.

Google Drive link

Services request from Primavet:

Radiography
Ultrasound
Echocardiogram
Blood test

Doctor Notes

Please add any information that is pertinent to the patient's reason for referral.