Great news! Dr Reagor has returned to Riverbend full-time! We are thrilled to announce that we are now accepting new clients and, to better serve our community, offering same-day appointments, including urgent care services.

Referral Form

Complete the form below to refer a patient to Riverbend Animal Hospital. If you have any questions, contact our veterinary team.

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Referral Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pets before your visit.

You may use the PDF version by clicking the DOWNLOAD FORM button and completing the printed form by hand. Once completed, please email the form to riverbend@riverbendanimal.com.

Download Form

Date:

Referring Veterinarian: *

Hospital Name: *

PLEASE HAVE THE OWNER CONTACT US TO SCHEDULE AN APPOINTMENT!

Client Information

Client Name: *

Preferred Contact Number: *

Email *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Patient Information

Pet Name: *

Species: *

Breed:

Color:

Age *

Weight (lbs.): *

Notes on temperament:

Are pre-visit meds needed?: *

Medical History

Presenting Complaint/Problem: *

Rabies Vaccination Date:

FVRCP/DA2P Date:

Additional Vaccines & Dates:

FeLV/FIV Test Date:

Last HW Test Date:

Additional History:

Current Meds/Therapies: *

Diagnostics Performed: *

Referral Form

Referral Form

PLEASE HAVE THE OWNER CONTACT US TO SCHEDULE AN APPOINTMENT!

Client Information

Patient Information

Medical History

Book An Appointment

Have a Question?

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Location

Hours