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Tidewater Veterinary Internal Medicine
Virginia Beach Veterinary Specialist Care for pets in eastern Virginia Virginia Beach

Keith A. Kremer, DVM, DACVIM
Board-certified Specialist in small animal Internal Medicine

(757) 605-1610 clinic@specialistvet.com

Welcome to Our Site

Go Green!  Online Referral Form for Veterinarians

You may now submit your referral electronically.  I encourage you to do this for a number of reasons, including ease of use, legibility of information (no more trouble deciphering doctor's handwriting!), more thorough referral information, and of course to help conserve paper and ink.  Referral reports will still be faxed to you as usual, although I hope to provide electronic referral reports in the coming year.

Form - Vet Referral Online Form

Referring Veterinarian (required)

Clinic (required)

Clinic Fax # (required)

Clinic E-Mail Address :
Client name (required)

Address (required)
Street Address (required)
City (required)
State/Province (required)
Zip/Postal Code (required)
,
Preferred client phone # (required)
Phone TypePhone Number (required)
Patient name (required)

Species (required)
Dog
Cat
Breed (required)

Patient age (years) (required)

Patient sex (required)
male neutered
male intact
female spayed
female intact
Vaccinations (required)
current
overdue
Most recent fecal analysis. Please list findings if positive. (required)

Most recent heartworm test. Please list if positive. (required)

Test results being sent with referral (required)
cbc
chemistries
urinalysis
thyroid testing
Chest Xrays
Abdominal Xrays
4Dx
Felv/FIV
Other
Other / additional test results

Reason for referral (required)

Previous treatments (required)

Additional comments

Please send us more
brochures
business cards
referral forms
consult forms

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