Open 24 hours a day
7 days a week!

800 W. Jericho Turnpike,
Huntington, NY 11743

Call us at 631-351-6116

West Hills Animal Hospital and Emergency Center

Our clients never pay any additional emergency fees!

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Electronic Referral Form

HomeResourcesReferring Veterinarians

This form can also be printed and faxed by clicking here or sent with the client. Please include the most recent notes, radiographs, and any pertinent lab results when possible.

Date:

Referring Hospital Name:

Phone #:

Fax:

Referring Veterinarians name:

Referring DVM / Hospital Email:

Which method of communication would be most convenient to receive Admission and Discharge Summaries of your patients?



Combination (Please list):

Clients name:

Client address:

Home phone:

Cell phone:

Email:

Patients name

Age:

Sex:

Species/Breed:

Color:

Weight:

Please Select Service:
  Emergency & Critical Care Center
  Rehabilitation Services - Victoria Kearns, LVT, CCRP, NCM, OACM
  Cardiology Services - Keith Blass, DVM, MS, DACVIM
  Surgery Services - Matthew Raske, DVM, DACVS-SA, Ariel Kravitz, DVM, DACVS-SA, & Mark Levy, DVM, DACVS-SA
  Oncology Services - David Hunley, DVM, DACVIM
  Dentistry Services - Donald DeForge, VMD (Practice limited to Dentistry)
  Acupuncture & Integrative Medicine - Dawn Greenberg, DVM, CVA

Presenting Complaint:

Brief History:

Current Treatment and Medications:

Additional Information Comments:

24hr Emergency Veterinarians in Long Island NY

24hr Emergency & Critical Care Center

Clients of West Hills Animal Hospital & Emergency Center never pay any additional after-hours emergency fees!


Pet Owner Resources: