Patient Transfer to BluePearl in Grand Rapids -

Completing this form is optional. If you prefer, just give us a call. FOR EMERGENCY TRANSFERS, PLEASE CALL US. You are welcome to submit further information on emergency cases on this form. Grand Rapids: 616.284.5300

Primary DVM name*

Email for confirmation*

Hospital*

Client name*

Client phone*

I am transferring this patient to the following service:*

Emergency service, and if needed, transfer to a specialty service
Emergency service, and as appropriate, discharge the patient to go home or back to my hospital
Specialty service (please indicate service)

Is there a BluePearl DVM you have been speaking with about this case?

No
Yes, name

Pet name*

Species*

Canine
Feline

Breed*

DOB or estimated age*

Weight*

Units*

Reason for transfer to BluePearl, special requests, comments, current medications:*

Please send pertinent medical records to info.grandrapids@bluepearlvet.com or fax to 616.284.5320.

Diagnostics pending from (lab name)

Recent or pending diagnostics

Are you sending radiographs?

No
Yes, radiographs are being sent with the client.
Yes, radiographs are being emailed to info.grandrapids@bluepearlvet.com.
Yes, radiographs are being sent via Keystone.

Upload pertinent medical records and files

Drop files here or

For Veterinarians

Emergency?

Patient Transfer to BluePearl in Grand Rapids