DVM Referral Form

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, and send a confirmation email back to you indicating that we have received your information.

Note: If you would like to do a DICOM send directly from your digital radiography system to AEC, please contact us for assistance: DICOM Send.

Referring Veterinarian


Client Information


Patient Information

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

Text Us

Enter your mobile phone number below, and someone from Animal Emergency Center will respond with a text to your phone right away.

Don't worry - you can opt-out by texting STOP when you don't want to receive any more texts from us.