Texas Veterinary Referral Form

Rehab 4 Pets is a rehabilitation practice for small animals. We offer hydrotherapy (underwater treadmill), extracorporeal shockwave therapy, extracorporeal mechano-transduction therapy laser, chiropractic, customized bracing, exercise therapy and more.

Looking for the New Pet Sign Up Form?

Navigate to the New Patient Intake Form.

Go to Sign Up Form

Prefer To Use Pen & Paper?

Should you not want to complete the form below, please download the Texas Veterinary Referral Form.

Vet Referral PDF Form

FOR VETERINARIAN TO COMPLETE

Texas Veterinary Referral Form

Vet (Your) Email *

Veterinary Clinic Name *

Client's Name *

Client Cell Number *

Patient (Animal) Name *

Diagnosis *

Please include all pertinent medical information including medication profile, pre-existing conditions, diagnostic results, and any other relevant information.

Precautions or Contraindications *

Other Medical Conditions and Medications *

Declaration *

I as veterinarian have performed the following: 1. Established a valid veterinarian/client/patient relationship. 2. Examined the animal(s) to determine that the above therapies are appropriate.

By checking this box, I consent to receive marketing and promotional messages.

Disclaimer: Per Rule 573.14 of the Texas Administrative Code, the supervising Veterinarian will have established a veterinarian/client/patient relationship and determined that rehab services (an alternate therapy) will not likely be harmful to the patient.

Full Name (Yours as Vet) *

Please provide your full legal name as signature in agreement of the above.

Your Signature *

Clear