Veterinarian
Referral Form
Tel 401-886-6787
Fax 401-886-8998
Date ______________________
Service to which referred (circle one):
Specialty Services
Critical Care
Justine A Johnson DVM, DACVECC
Amy V. Trow DVM, DACVECC
Terry Hallowell DVM, DACVECC
Ophthalmology
Oncology
Neurology
Surgery
Client Name:
Internal Medicine
Radiology
Avian/Exotics
Patient Name:
Address
Tel #
Species:
Internal Medicine
Gary Block DVM, MS, DACVIM
Carrie Lester DVM, DACVIM
Rebecca Kessler DVM, DACVIM
ER / Critical Care
Breed:
Sex:
M
F
Age:
Neutered?
Y / N
Patient History
Diagnosis / Chief Complaint:
Neurology
Lauren E. Marini DVM, DACVIM
Ophthalmology
Marcia Aubin DVM, MS, DACVO
Oncology
David Hunley DVM, DACVIM
Surgery
George Coronado DVM, MS, DACVS
S. Christopher Ralphs DVM, DACVS
David C Sweet VMD, DACVS
Significant History / Treatments:
Diagnostics Performed:
(Please send radiographs & copies of test results with client or fax copies with referral form)
Are radiographs being sent?
Y / N
Tests pending (list):
Vaccination History:
Radiology
Susan M Newell DVM, MS, DACVR
Avian/Exotics
Lucy H. Spelman DVM, DACZM
Cardiology
Mark Stamoulis DVM, DACVIM
Current or Recent Medication or Therapy (include dosage/duration):
Referring Veterinarian Information
Name:
Phone:
Clinic:
Fax:
email:
OSVS is located at 1480 South County Trail (Route 2) in East Greenwich,
RI, 0.5 miles south of Warwick Showcase Cinemas.
From Points South and West:
Take Route 95 North to Exit 8A (Route 2 South). Go straight through the Division Street
(Route 401) intersection. OSVS is located 0.5 miles south of the intersection on the left.
From Points South and East:
Take Route 4 North to Exit 8B (Division St.). Pass the Cinema on the right and at the light
take a left onto South County Trail (Route 2). OSVS is located 0.5 miles south of the
intersection on the left.
From Points North and West:
Take Route 295 South to 95 South. Take Exit 8 (Route 2 South). Take a right off the exit.
Go straight through the Division Street intersection (pass the Cinema). OSVS is located
0.5 miles south of the intersection on the left.
From Points North and East:
Take Route 95 South to Exit 8 (Route 2 South). Take a right off the exit. Go straight
through the Division Street intersection (pass the Cinema). OSVS is located 0.5 miles
south of the intersection on the left.