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Transfer Form

This form is for veterinarians who are referring a patient for Overnight or Weekend care.

If you would prefer a hard copy please download, print and email a copy of the form to: reception@hbah.co.nz

Is patient insured?(Required)
Is the owner happy to be contacted by HBAH staff?(Required)
Clinical notes/diagnostics
If treatment plan requires modification call transferring vet?
Fluids Provided?
Medications Provided?
Medication
Drug Name
Dose Given
Volume
Frequency
Time Last Given
 
Overnight Hospital Care?
Critical Care Status
Discharge
Discharge plan has been discussed with owner
Cost has been discussed with owner