AECFV Referral Forms

Patient Direct Transfer Form

We have updated our direct transfer procedure. We hope this will provide an improved transition and experience for the client/patient from your clinic/hospital to ours.

The additional information being requested on the updated direct transfer form will assist our medical staff with providing the most prompt and accurate treatments.

Patient Direct Transfer Form

This updated form does request that a representative from your hospital call us prior to sending the patient or the form. Our reception staff will be asking a few basic questions to prepare our treatment staff for your patient. They also ensure that you have the most up to date forms. We want our hospital to feel confident about the transfer. We want the client to feel comfortable with the process. In order to make this happen, we require the information and documentation prior to meeting your client and their pet.

The Client Directions and Expectations handout is to be provided to any client that is being sent to our facility. We appreciate that a client may have a feeling of urgency when departing your facility. We want them to have transportable information that explains who we are, where we are and what to expect when they arrive.

Outpatient CT Request

We are offering out-patient CT scans. After receipt of the referral form we will contact the client directly to schedule an appointment. Scans are typically scheduled Tuesday through Thursday.

We will require all pertinent medical records and/or lab work. The interpretation report will be sent to you to discuss and follow up with your client.

Outpatient CT Request

Tonometry Referral Form

We can offer outpatient tonopen procedures for your clients. Please call us ahead of time so we can be prepared for your client’s visit.

These procedures will ideally take place after 5pm weeknights and after 9am on weekends.