Referral Form

We are a referral-based service. Please have your veterinarian fill out the referral form in order to access our services.

Patient Name

Date of birth

Sex

Breed

Does this patient have pet insurance and if so which one?

Owners Name (s)

Address

Main Phone

Secondary Phone

Referring clinic

Veterinarian name

Clinic email

Clinic phone number

Has this patient ever required pre-visit medications?

Will this patient be amendable to examination in lateral without pre visit medications? Keep in mind we are a house call service.

Have pre-visit medications been dispensed?

Reason for referral

Brief History of current issue

Other medical issues

Medications currently on

Please note that we do not have the ability to take radiographs. Cancer in our treatment area is a contraindication for laser therapy. If you feel cancer is a differential for this patient’s pain you may want to take radiographs prior to referral.

Last known bloodwork

Anything else we should know?

Please ensure that your uploaded files are in one of the accepted formats: JPG, PNG, GIF, PDF, DOC, or DOCX. Files in any other format will not be accepted. Maximum file size 10MB.

Upload Medical Record

Upload Bloodwork or X-Rays

Upload Multiple Files

House Calls

Have your veterinarian send us a referral to schedule your pet’s first assessment.

Benefits of House Calls:

Convenience, stress reduction for pets, personalized home environment assessment.

How to Prepare:

Please find a space that is comfortable for both you and your pet but that also has space for them to move around a bit.

We may have them lay down so having their bed handy is also a great plan. Going outside for a brief walk may be part of the exam so having a leash and your jacket handy is also ideal. Have a list of any questions you might have.

We will bring our own treats, but having some of your pet’s favourites handy is a good idea.

What to Expect:

A typical house call starts with getting to know you and your pet and making sure everyone is comfortable. We then will go over the history and questionnaire you were provided with. This is also a time to ask questions and discuss your goals. After that we will examine your pet. Depending on the problem area this may be done part in standing and part laying down. We may go for a short walk outside to see them move as well. After that we will go over the findings and discuss your goals.
We will then formulate a plan based on these goals.

EXISTING CLIENTS ONLY

Referral Form

House Calls

Have your veterinarian send us a referral to schedule your pet’s first assessment.

E-MOTION
Veterinary Rehabilitation

Dr. Amanda Ahokas

Referral Form

House Calls

Have your veterinarian send us a referral to schedule your pet’s first assessment.

E-MOTION Veterinary Rehabilitation

Dr. Amanda Ahokas

E-MOTION
Veterinary Rehabilitation