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Veterinarian Referral Form

Fill out the form below and we will respond back to you as soon as possible

If this is a medical emergency, please reference your RDVM Polar Eyes Veterinary Ophthalmology reference packet for our after-hours emergency phone number. If we do not answer, leave a message and we will return your call ASAP. 
 

Referring Hospital *
Email *
Referring Veterinarian *
Client Name *
Client Phone *
Client Email *
Patient  Name*

Signalment

Species *
Breed *
Date of Birth *
Sex *
Weight

Patient History

Services Requested (consultation, surgery, CAER/OFA etc.)
Presenting Complaint *
Onset and Duration of Problem *
Current Medications and Dosage *
Ongoing or Additional Medical Conditions 

Labs and Images

Upload Files

We will be in touch soon!

Contact

Contact Us

Email

info@polareyesvet.com

Hours 

Monday - Thursday 8:00 AM - 6:00 PM

 

After Hours Available Via Emergency Clinic Consults Monday thru Friday

Service Locations

Anchorage

Anchorage Veterinary Clinic & Urgent Care

8811 Toloff Street

Anchorage, AK, USA

 (907)268-2242

Valley

North Star Animal Hospital

840 S. Cobb Street

Palmer, Alaska 99645

 (907)746-7387

Fairbanks

North Pole Veterinary Hospital

2942 Hurst Road,
North Pole, AK 99705

(907) 488-2335

AND

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