Referring Veterinarian Report to Specialist

Referring Veterinarian Report to Specialist at Garden State Veterinary Specialists

246 Industrial Way West, Eatontown, NJ 07724
Name of Veterinarian Referring Patient*

First NameLast Name
Date*

MonthDayYear
Date
Referring Hospital *

Hospital Name

Hospital Address

CityState / Province

Postal / Zip Code
Hospital Phone Number or Best Contact Number for Referring Veterinarian:*

Area CodePhone Number
Hospital email address for Reports on Referred Cases
example@example.com
Hospital Fax Number for Reports on Referred Cases

Area CodePhone Number
Referred Owner's Name*

First NameLast Name
Referred Owner's Phone Number*

Area CodePhone Number
Patient Name*
Species: *
If you chose other for species, please indicate type below:
Breed:
Age:
Sex: *
Patient History:*
Reason for Referral*
Drugs Administered (Include dosage and Time administered):*
Please send all relevant medical records, including lab reports, digital radiographs, CTs, or MRIs to GSVS by email to medrecs@gsvs.org or by fax to 732-922-0991.

We invite you to call our hospital to discuss your referral, 732-922-0011.
Medical records can be uploaded using this link from your computer

Browse Files

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Garden State Veterinary Specialists, founded in 1994 by Dr. Thomas D. Scavelli, is a 24 hour referral hospital and emergency/critical care facility staffed by a team of experienced, dedicated specialists utilizing state of the art diagnostic technologies and performing cutting edge medical procedures in a caring and compassionate environment. The GSVS team is committed to making the referral experience one of personal service.

Thank you for the courtesy of this referral!
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Referring Veterinarian Report to Specialist at Garden State Veterinary Specialists