Referral Form

Thank you for referring to Vision Vets For Pets. We truly value your referral and are looking forward to working with you!

We pride ourselves on a straightforward, reliable, accessible, and highly effective specialty service for referring veterinarians. We endeavor to see all new patients with minimal wait times to ensure client satisfaction and excellent outcomes.

Reserved appointments are available for urgent cases. We know that sometimes eye problems just can’t wait! Please call our team by phone (after submitting the webform) if you think a case should be urgently seen.

Please complete the following form for all new referrals to Vision Vets For Pets. If our team has questions, we may reach out to you for additional clarification.

For questions or feedback, please directly contact our team using the number below, or submit a request using the Contact section of our website.

Call Vision Vets For Pets: (865) 357 4040

Referring Doctor Name

First Name

Last Name

Hospital Name

Hopital ZIP code

Clinic Phone

Include area code

(###)

###

####

Clinic Email

If no email, write 'no email'

Clinic Fax

If no fax, write 'no fax'

How would you prefer to be contacted regarding this case?

Fax

No preference

Owner's Name

First Name

Last Name

Owner Email

If no email, write 'no email'

Pet's Name

Owner's Phone

Include area code

(###)

###

####

Owner Alternate Phone

Include area code

(###)

###

####

Pet's Date of Birth

YYYY

Species

If species is 'other', please specify here

Sex

Breed

What is the tentative diagnosis?

Concurrent systemic health issues

Write 'none' if no known concurrent significant health issues.

If the patient has diabetes, is the blood glucose currently well controlled?

Yes

Not applicable (not diabetic)

Current medications

Include both systemic and ocular medications. Write 'none' if no current medications.

a brown dog with beautiful eyes and good eyesight in a field

Referral Form

Call Vision Vets For Pets: (865) 357 4040

Location