Rehabilitation Referral Form

Notice: Hydrotherapy is temporarily unavailable and new rehab intakes (except chiropractic) are paused. Please contact your technician if you haven’t already been reached.

Important Update: Rehabilitation Department

We want to inform our rehabilitation clients that our hydrotherapy treadmill has unexpectedly stopped working. As a result, we are currently unable to provide hydrotherapy services for animals in our rehabilitation department.

Effective immediately, we are also placing a pause on all new rehabilitation intakes (outside of chiropractic) until further notice.

We understand how important these services are to your pet’s recovery and well-being, and we sincerely apologize for the inconvenience this may cause.

If you have not already been contacted by your rehabilitation technician, please reach out to our team to discuss your pet’s current rehabilitation plan and determine whether any adjustments are needed.

Thank you for your patience, understanding, and continued trust in our team as we navigate this unexpected interruption in service. We will share updates as more information becomes available.

*Please note this form is for referring veterinarians only. If you would like a referral, please contact your regular family veterinarian.

REFERRING VETS: When referring your patient to our hospital, please complete this form and upload all pertinent medical records.

Hillside Veterinary Hospital reserves the right to discontinue services if appointments are repeatedly missed without notice.
Please ensure any referred clients are made aware of this policy prior to referral.

REFERRING VETERINARIAN INFORMATION

Name of Referring Veterinarian *

Hospital/Clinic Name *

Hospital/Clinic Phone Number *

Hospital/Clinic Email Address *

OWNER INFORMATION

Full Name *

Name of secondary contact and/or spouse

Address *

City *

Province *

Postal Code *

Phone Number*

Email Address *

PATIENT INFORMATION

Patient's Name *

Species *

Breed *

Temperament *

Sex *

Age *

In months/years, or birthdate

Colour / Markings *

Weight *

In kg

REQUIRED DOCUMENTATION / INFORMATION

Reason For Referral *

Diagnostic procedures performed/planned, include dates, please send all relevant imaging *

Treatments/Surgeries with dates *

Current medications, supplements

Additional Comments

Upload Required Documentation (medical records, lab work, imaging, etc): *

Security Question *

I HAVE READ AND UNDERSTOOD THE PRIVACY POLICY *