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Charleston Veterinary Internal Medicine Referral Form
If you are unable to submit the referral form online, please email all records to info@charlestonveterinaryinternalmedicine.com
Please make sure you include the following:
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Date
Veterinary Practice
Referring Veterinarian
Phone
Client Contact (If the client will need to call Charleston Veterinary Internal Medicine or if the client needs to be contacted)
Client First and Last Name
Client Phone
Patient Name
Species
Breed
Patient Age
Sex of Patient
Approximate Weight
Reson for Referral
Current Medications
Upload of Medical Records
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