Skip to main content

Equine Referral Form

This service is for veterinarians only – clients seeking medical information should contact their regular veterinarian for assistance.

If you would like to make a referral to one of the VH Services and you do not need to talk to a VH clinician, you can use this form to submit the client and patient information. Please indicate on the form if you have told the client to call the VH, or if you would like us to call them. Please provide a summary of the history of the case so that we can be prepared to provide the patient with the appropriate care. Please send or fax supporting information. Please send radiographs or other images with the client or by submitting directly to us through eFilm (see instructions on main information for Referring Veterinarians page).

Veterinarian Contact Information

Referral Status(Required)
Veterinarian to Contact(Required)

Owner Contact Information

Client Contact(Required)
Name of the owner(Required)

Information about the patient

Has this patient ever been seen by any service at NC State Veterinary Hospital?
Reason for referral (select one)
Diagnostic data accompanying referral (please fax or send with client)