(978) 779-2955 info@iahcbolton.com

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We will be closed on Monday, May 25th, in observance of Memorial Day.

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.

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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.

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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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