2619 SW 17th St, Topeka, KS 66604
(785) 233 - 3185

Patient Referral Form

Thank you for giving us the opportunity to work with you, your patient, and your client. So that we may better understand this case and the goals you have in managing it, please provide us with the following information.

Fields marked with an asterisk (*) are required.

We require all services to be paid for at the time they are performed. In order to help control the escalating costs of medical care, University Veterinary Care Center no longer allows charging bills  to personal accounts. To help clients spread the expense of larger bills, we offer credit srvices through CareCredit and Scratchpay. By signing here, you indicate you are aware and agree to our payment policy. Additionally, with respect to the above listed patient, you consent to share medical records with the referring practice and veterinarian for the purpose of collaborating the best treatment plan for your animal. You are at least 18 years of age and are the owner or representative agent of the pet described above.

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