Veterinary Referral Form

Hi there, please fill out and submit this form.

17 Questions

Date *

Referring Veterinarian Information

Veterinary Hospital *

Referring Doctor's Name *

How would you prefer to be contacted about this case? *

How would you prefer to be contacted about this case?

Phone Number *

Requested Service *

Internal Medicine
Neurology
Physical Rehabilitation
Surgery
Cardiology
Dermatology
Ophthalmology
Emergency (transfer/immediate referral - please call)
Critical Care (transfer only - please call)

Patient should be seen: *

Within 24hrs. (transfer/emergency)
Within 24-72 hrs
3-7 days
>7 days

Client Information

Records: Past be

Client(s) Name *

Client(s) Name

Client's Phone Number *

Best Contact #

Client Email *

Client Email

Patient Information

Patient Name *

Patient Name

Patient Breed *

Breed

Patient Sex

Sex

Patient Altered

Altered

Patient DOB *

DOB

Radiographs, Medical Records: *

Upload Records Here
Will be faxed
Client will bring
Email

When sending your patient referral, please send all patient medical history and diagnostics. We will be unable to move forward with your pending referral until all information is received. This includes the medical records, blood work, outside lab results (cytology, biopsies, etc.) and all imaging (radiographs, ultrasound images, CT/MRI etc.)

Reason for Referral: *

Past Relevant History *

Previous/Current Treatment(s) or Medication(s): *

Directions to New River Veterinary Specialists

Please refer to the directions below or call NRVS @ 843.898.6787 for assistance. NRVS address is 600 Argent Blvd. Hardeeville, SC 29927.

Coming from south of Hardeeville:
Take I-95N to Exit 8. Once at Independence Blvd (Hwy-278E), turn RIGHT. Stay on Independence Blvd for 5.2 miles (~ 10 minutes). Turn LEFT onto Argent Blvd. You will see a Wal-Mart Supercenter on your right, once you turn left. Continue down Argent Blvd. for 0.6miles (~2 minutes) and New River Veterinary Specialists will be on the right-hand side of the road.

Alternate route from south of Hardeeville (Downtown Savannah):
Take US-17N for 6.2 miles and slight RIGHT to merge onto I-95N. In 2.9 miles, take Exit 8 to merge onto Independence Blvd. (US-278E). Continue down Independence Blvd (Hwy-278E) for 5.2 miles. Once you turn LEFT onto Argent Blvd. You will see a Wal-Mart Supercenter on your right. Continue down Argent Blvd. for 0.6miles (~2 minutes) and New River Veterinary Specialists will be on the right-hand side of the road.

Coming from north of Hardeeville:
Take I-95S to Exit 8. Turn LEFT onto Independence Blvd. (Hwy-278E). Continue down Independence Blvd (Hwy-278E) for 5.4 miles. Once you turn LEFT onto Argent Blvd. You will see a Wal-Mart Supercenter on your right. Continue down Argent Blvd. for 0.6miles (~2 minutes) and New River Veterinary Specialists will be on the right-hand side of the road.

Alternate route from north of Hardeeville (Beaufort Area):
Take Robert Small Pkwy (SC-170W) for 15.9 miles. Take a slight RIGHT towards Argent Blvd. Stay on Argent Blvd. for 3.2 miles and New River Veterinary Specialists will on the left-hand side of the road.

Coming from Hilton Head Island (East):
Head west on William Hilton Pkwy (US-278W) for 6.8 miles. Keep RIGHT to continue to William Hilton Pkwy for 8.8 miles. Turn RIGHT onto Argent Blvd. You will see a Wal-Mart Supercenter on your right. Continue down Argent Blvd. for 0.6miles (~2 minutes) and New River Veterinary Specialists will be on the right-hand side of the road.