Patient Transfer Info Sheet

Referring Hospital(Required)

Doctor(Required)

Contact #:(Required)

Date(Required)

**If your patient should deteriorate or TX plan is changed do you want to be contacted?**(Required)

Yes

Owner:(Required)

Address:(Required)

Phone:(Required)

Patient:(Required)

Canine

Feline

Age

Sex:

Breed:

Color:

Phone # to be reached at:

Presenting Complaint

Diagnostic Results:

Diagnosis:

Treatment Plan:

Fluids:

Type:

Rate:

Amount Administered:

Medications:

Dose:

Time Last Given:

Medications:

Dose:

Time Last Given:

Medications:

Dose:

Time Last Given:

Medications:

Dose:

Time Last Given:

Send photos of what medication of what the client pets ate, or paperwork health:

Max. file size: 5 GB.

**PLEASE INFORM OWNERS THAT THEY MUST CONTACT ANIMAL EMERGENCY CENTER WITHIN ONE HOUR OF ARRIVAL TO DISCUSS TREATMENT PLAN, ESTIMATE AND PAYMENT ARRANGEMENTS.**

THANK YOU FOR THE REFERRAL.

Contact Info

3340 E Patrick Ln
Las Vegas, NV 89120

Phone: 702.457.8050
Email Us: aecpeter@yahoo.com

Office Hours

Mon & Fri:: 6:00 PM - 8:00 AM
Holidays, Sat - Sun:: 24 Hours

Special Offer

10% discount for senior citizens and veterans and active military