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Emergency
Facebook
- Buzzards Bay
- South Dennis
Contact Buzzards Bay
- 508-759-5125
- Email Us
  (non-emergent)
Contact Dennis
- 508-398-7575
- Email Us
  (non-emergent)

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Cape Cod Veterinary Specialists

General Referral Form

Name: Cape Cod Veterinary Specialists
Address: United States
Telephone: 508-759-5125
Price range: $

Complete our general referral form online from any device at any time.

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Online Forms

General Referral Form

Download Form

For your convenience, you may complete this referral form and submit through our website. One of our team members will be in touch with you as soon as possible. You may also print this form to fax, mail, or hand deliver to our office.

Please be sure to fax and/or send all pertinent records, reports, and diagnostic images with the pet owner to the appointment. Our fax number is: 508-759-9861.

Date *

Hospital Referring To *

Buzzards Bay
Dennis

Doctor Information

Doctor Name *

First

Last

Practice Name *

Laboratory Name

Doctor E-mail *

Doctor Phone *

Doctor Fax

Would you like to receive a call?

Yes, on Day of Discharge
Yes, on Day of Exam
No

Client Information

Client Name *

First

Last

Client Phone *

Client Address

Address Line 1

Address Line 2

City

State

Zip Code

Patient Information

Patient Name *

First

Last

Patient Species *

Breed *

Age *

Weight *

Sex *

Case History

Vaccine History

Please enter dates last given.

Distemper *

Rabies

Kennel Cough

FELV

Please upload lab reports, x-rays, and other diagnostics.

Click or drag a file to this area to upload.

Additional Upload (if necessary)

Click or drag a file to this area to upload.

Additional Upload (if necessary)

Click or drag a file to this area to upload.

Additional Upload (if necessary)

Click or drag a file to this area to upload.

If you cannot attach diagnostic results, please summarize:

Radiographs

I attached them above.
I will bring them with me.
I will mail them (CCVS will mail them back promptly).

Current Therapy and Medication

Please include dosages.

Additional Comments/Requests

THANK YOU FOR YOUR REFERRAL FROM CAPE COD VETERINARY SPECIALISTS. You will receive a detailed letter from the specialists describing findings, recommendations and treatment. Thank you again! If there is any other comments, please include them here.

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