Online Case Reference System
(Interventional Medicine Service – Small Animal Hospital)

Type of visit
UrgentNext available appointment

Reference reason

If your client has already made an appointment, please indicate the pre-submission number sent to you by email :

Informations about the referral veterinarian

Referring clinic

Veterinarian

Phone number

Second phone number

Email

Informations about the client

First name and last name

Phone number

Second phone number

Email

Informations about the patient (If the medical file is sent by email at reference@chuv.umontreal.ca or join to this form, you can skip this section.)

Medical file (Max 2 MB)

Name of the animal

Second phone number

Check if already referred in the past :
already referred in the past

Species

Breed (if known)

Age or date of birth

Weight

Sex
MaleSterilized maleFemaleSterilized femaleUnknown

Anamnesis

Diagnostic

Summary of laboratory results

Max 2 MB per document

X-rays

Max 2 MB per document

Treatments and treatments responses

Other relevant informations

Comments about the online case reference system