Lisa Carr - Owner and Founder - Maryland Avian and Exotic 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the Referring Veterinarian/Hospital Information section. Enter your name, hospital name, address, telephone number, email, state, zip code, and fax number.
3. Next, move to the Patient Information section. Provide the patient's name, date of birth (DOB), gender (select Male or Female), age, whether they are spayed/neutered, species and breed, and color.
4. In the Pet Owner’s Name and Contact Information section, input the owner's name, address, home telephone number, email address, state, work telephone number, zip code, and mobile telephone number.
5. Proceed to the Patient Case History section. Indicate the condition of the patient (Healthy, Stable, Critical) and detail any presenting complaints or chief medical concerns.
6. Specify the reason for referral and provide pertinent medical history along with current diagnostics/treatment medications including dosages.
7. Finally, indicate what documents you are sending with the patient such as a copy of the entire medical record, lab reports, radiographs or other relevant information.

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