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Please Note: Our office will be closed on Saturday August 30th and Monday September 1st in observance of Labor Day. We will reopen for normal business hours on Tuesday September 2nd.

Veterinary Rehabilitation & Hydro Therapy Referral Form

Save time during your next appointment! Complete your required forms online from any device at any time before your visit.

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Referring Veterinarian

Name *

Phone *

Clinic

Fax

Email *

Address

Address Line 1

Address Line 2

City

State

Zip Code

How would you prefer to be contacted? *

Email
Fax
Mail

Client

Name *

Home Phone

Cell Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Pet’s Health History

Pet's Name *

Date of Birth

Type of animal *

Breed *

Sex *

Male
Neutered
Female
Spayed

Reason for referral:

Concurrent medications:

Sending with Patient:

Recent Labs
X-rays
None

Referring Veterinarian Signature: *

Clear Signature

Please note: Completion of this form authorizes IAHC to evaluate and treat this rehabilitation patient. Clients seeking any other services will be redirected to the referring doctor. Thank you.

Phone

Request an Appointment

We are a full-service veterinary hospital committed to giving your pets the best care possible. Click on the button to request an appointment with us today; we look forward to serving you and your pet.

Appointment

Have A Question?

Please complete the form below, and a member of our team will get back to you as quickly as possible.

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Location

556 Main St.
Bolton, MA 01740

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Contact Information

Phone: (978) 779-2955
Email: info@iahcbolton.com

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Hours

Mon-Fri: 8:00 AM – 5:00 PM
Sat: 8:00 AM – 12:00 PM
Sun: Closed

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