Rehab Referral

Thank you your interest in the Sears Animal Hospital rehab referral program!

 

Please take your time to read all of the sections and questions. If you have any questions, please call the clinic at 519-661-0496 or email info@searsanimalhospital.ca.

 

Our Rehab Team includes:

 

Dr. Bonnie, DVM CCRT - our rehabilitation veterinarian that will take the cases with an unknown diagnosis to determine next steps. This is our only vet with the CCRT designation that can perform the rehab consults.

 

Our other veterinarians can examine and work with the CCRP/rehab technicians/RVTs to determine next steps on a case that is diagnosed by the RDVM. After the initial assessment, rehab therapies will be administered by a CCRP or RVT under the guidance of a CCRP.

 

Kathy, RVT CCRP is our rehab technician that will determine the next steps for a patient based on an RDVM's diagnosis.

 

Our Nutritional Advocates will help to manage the weight loss and joint mobility concerns through diet and supplements in combination with the rehab department.

 

The veterinarian evaluation will be strictly to do with the rehab program and not a generalized examination. Through the referral program we will not be accepting the clients to transfer to our clinic fully, unless a transfer is requested by the client and they have contacted yourselves for further explanation. We will not be treating conditions or ailments outside of those related to the Physical Rehabilitation Program. These concerns will be referred back to the RDVM. At the RDVM requests, the records can be sent back to the RDVM as often as desired, otherwise the records will be sent after the graduation of the rehab program.

 

After the referral has been submitted, our team will reach out to the owner within 1-2 weeks with a consult price and estimate, date/time to come in and any information the client would like to know. There will be a contact maximum of 3 attempts, after this a new referral form will be required to submitted.

 

Please send completed radiographs and bloodwork (including Heartworm/4Dx results). These will be assessed, however, please advise your clients that the radiographs may need to be repeated based on our orthopedic surgeon's requirements.

 

***Rabies vaccine is required to be up to date prior to booking for referral***

 

Please let owner(s) know that we will be contacting via email with an estimate once the referral has been viewed, emails will occasionally go to the junk box. If they have not received an email or phone call 1.5-2 weeks after this referral has been submitted, ask owners to give us a call so we can confirm if we have attempted to contact.

 

We are currently booking out 1-2 weeks for patients with confirmed diagnoses, and 4-6 weeks for patients without a diagnosis.

 

I have read, understood and agree with the terms of the referral as described above. *

 

REFERRING CLINIC INFORMATION

Please ensure to provide the most up-to-date information possible. We understand changes are frequent within clinics, however, to avoid any confusion, we prefer to communicate with a single veterinarian or veterinary staff member.

 

CLIENT INFORMATION

PATIENT INFORMATION

If mixed breed, please list the visually dominate breed first then the secondary breed.

Body Condition Score (9 Point Scale) *

Patients BCS as per the last visit on the 9 Point Scale where 1 is Emaciated, 5 is Ideal and 9 is Severely Obese.

Please provide weight in kilograms.

HISTORY AND INQUIRY

Please provide any general ailments and previous diagnosis that may or may not inhibit treatment protocols. This will help give the Rehab Department indications and contraindications for each modality.

 

Limb(s) Affected (select all that apply) *

Please list one condition per line. Please include any allergies or reactions (food or medications).

Are you sending attachments? If so, please send to info@searsanimalhospital.ca *
Is this a orthopedic surgical and rehab referral or rehab referral only? *

In the case of a orthopedic surgical and rehab referral, please be advised our orthopedic surgeon needs very specific radiograph views. Due to this, we ask you allow us to take radiographs to ensure the clients do not have to pay for additional radiograph fees.

 
Rehab Modality Inquiry *

Please select each modality you wish to include in the patient's program.

 
Security Question *