Veterinary Teaching Hospital Referral Data Form

University of Illinois, Veterinary Teaching Hospital 1008 West Hazelwood Drive, Urbana, IL 61802


Instructions

This form is for our referring veterinarians to complete. If you are a client seeking medical advice for your own pet or animal, please contact your veterinarian. If this is an emergency, please call the main hospital at 217-333-5300 (Small Animal) or 217-333-2000 (Large Animal).

Veterinary partners, please answer the questions below to submit the referral form for the University of Illinois Veterinary Teaching Hospital. This will go to our medical records service.

If you do not upload them below, all pertinent patient medical records, including imaging, should be sent to our medical records service at:

Medical Records email – medrec@vetmed.illinois.edu
Medical Records fax – 217-244-9554

Please have someone from your clinic or the client call to schedule an appointment.

Contact Numbers for Referring Veterinarians only

SAC: 217-333-5311
LAC: 217-333-2001

Contact Numbers for Clients

SAC: 217-333-5300
LAC: 217-333-2000
VMSC: 217-244-2555


Referring Veterinarian Information


Owner Information


Animal Information


Medical Information

Several images types supported (i.e. jpg, jpeg, gif, png, bmp). Documents and pdfs can also be uploaded farther down in the form. Video file upload not supported.

Several document types supported but pdf preferred. Images should be uploaded above. Video file upload not supported.

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