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If you prefer to fax us a referral, simply print and fax this form: Referral Form.

If you would like to refer a patient to AEC using our online submittal, please complete the form below...

You may optionally upload any diagnostic files, x-ray .jpg images or other patient documents as required. We will process your submittal at the hospital location you select.

Referring Veterinarian

Client Information

Patient Information

You may attach lab data, radiographs, or additional files below.