Referral Form

Radiographs sent to AEC with patient?*

Radiographs to be performed at the AEC?*


  1. Treatment sheets must be prepared by rDVM
  2. Please do not send medications except:
    - oral medications
    - current IV bag
    - injectable medications that have been reconstituted, labeled w/strength(mg per ml),date & time of reconstitution
  3. ALL medications must be accurately labeled or will not be given
  4. Owner and rDVM phone numbers must be available should patient condition require deviationfrom treatment protocol.


  • Entrance exam fee: $60.00
  • Daily evaluation exam fee: $50.00 (every 24 hrs)

If patient condition changes or an alternate/additional diagnosis is determined by the AEC staff, the AEC reserves the right to deviate from the minimal intervention program WITH CONSENT of owner or rDVM. The AEC will do their best to inform them in the event of an emergency situation where a life-threatening problem occurs.

I am requesting the above protocol for my client.