North Carolina State University College of Veterinary Medicine

Please use this form to submit a referral request to the Veterinary Health Complex.

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 VHC Services and you do not need to talk to a VHC 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 VHC, 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).

If this is an EMERGENCY REFERRAL (i.e. needs to be seen within 24hrs), please call the appropriate service immediately after submitting the information below.

Veterinarian Contact Information
Owner Contact Information
Information about the patient Gender
Reason for referral/clinical history
(include duration of illness, signs)
Client Contact
Diagnostic data accompanying
referral (please fax or send with client)
Vaccination History (please enter date administered)
Canine Feline
Medical reason precluding
rabies vaccination (if any):
NCSU Estimate provided to owner (if any):