REFERRAL FORM - use AFTER scheduling consultation time

If your clinic does NOT have a previously scheduled SEVC consult day, please schedule a consultation time FIRST.   

  • Up to THREE cases can be evaluated per 90 min consult time

    • Keep track internally (on your clinic's own schedule) of what and how many cases are being scheduled for your clinic per consult time. Each clinic is responsible for scheduling/confirming dates with clients

    • SEVC will have record of what cases are to be seen each day based on referral form submissions, but again, each clinic should keep track of this as well.

  • Please note that the online scheduler and referral forms are separate - your cases submitted via the referral form will not populate into the online scheduler. The referral form is just to provide information for each patient you wish SEVC to evaluate.

  • Include detailed pertinent history and current medications with dosing amount/frequency

    • This information is required for SEVC to provide accurate  recommendations to you and your clients.​

  • ***Email will be the primary method used to confirm/adjust consultations - please include a monitored, general clinic email address to prevent delays.*** 

  • Travel Fee - will be applied for consultation times with only one case. Scheduling two or more cases will remove any travel fee. See the SEVC consultation information sheet provided to your clinic for specific amounts.

  • Cancellation Fee -  may also apply if only one case is scheduled and cancels within 24 hours prior to consultation, or no-shows.


If you are a pet owner, please contact your primary care veterinarian to have them schedule a cardiac evaluation in their hospital with SEVC.  

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Thanks for submitting! If desired, another case can be added at this time, or feel free to come back later!