General Hotline : 3650 3000

24-Hour Emergency Hotline : 3650 3200

For Referring Clinics

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Referring cases to CityU VMC

Referring cases includes: Emergency and Critical Care, Dentistry/Oral Surgery, Dermatology, Internal Medicine, Neurology, Oncology and Surgery can be arranged by filling in the online form below. You may also download the form and email or fax the completed form to us.

It will be helpful to attach Patient History and give as accurate as indication in determining the urgency of the problem, so that we can schedule the appointment with the client as quickly as needed.

Fax: 2715 3490

Email: info@cityuvmc.com.hk

Referral
ECG service referral

Download Form

This form is also available as a fillable PDF

rDVM Information

Veterinarian Name

Veterinary Clinic

Clinic Phone

Fax

Address

Preferred correspondence EmailFax

Owner Information

Mr.Mrs.Ms.

Client No.

Name

Phone

Patient Information

Patient Name

Breed

Date of Birth / Age

Species CanineFeline

Sex MaleFemale

Neutered YesNo

Allergy for any medication, please specify

Referral Service Request

Please choose a service

Others, please specify:

Special Arrangements Necessary
Our Referral Coordinator will contact you to facilitate any special needs for your patient and client

EMERGENCY 24/7/365
*A completed referral form NOT required for access to our emergency department

Reason for request Please tell us why you are seeking this consultation

History of Present Illness Pleass include clinical signs, and their onset, duration or progression, and severity

Summary of clinical findings Please include date(s) and pertinent results. Please send lab reports and imaging

Current Treatments Please include any current or previous treatments associated with this illness and response

Specific Questions, Comments or Concerns, and Special Arrangement Details

Please submit patient history and digital images (e.g. laboratory reports and radiographs, X-Rays)
File format (PDF / JPG / ZIP), each file must not exceed 2MB.

Keeping clients and referring vets updated
We will update you with developments of the case as early as possible, in the form of an emailed referral letter, or an updated patient history. Hospitalized patients are continuously monitored, and the client will be updated on patient progress daily if needed.

Download Form

This form is also available as a fillable PDF

RDVM Information

First Name Last Name Mobile

Address

Fax Email

Clinic/Hospital

Client Information

Mr.Ms.Mrs.

First Name Last Name Mobile Home Phone Business Phone

Client No. Email Address

Patient Information

CanineFeline

Patient Name

Breed

Date of Birth / Age

Colour

Weight

Weight Unit lbskg

Neutered YesNo

Sex MaleFemale

Referral Information

Provisional diagnosis and reason for ECG

Preferred time Not Urgent (next available appointment)Emergency (within 1 day)Urgent (within 2 days)

Time of onset of problem

Heart Murmur

Heart Murmur Grade

Point of maximal intensity

Exercise intoleranceSyncopeEchocardiography / chest radiographs performed - please state pertinent findings

Special questions to be answered

Prefer receive report by EmailFax

Any additional things you want to tell us?

Please submit patient history and digital images (e.g. laboratory reports and radiographs, X-Rays)
File format (PDF / JPG / ZIP), each file must not exceed 2MB.

Remarks:

PRICES for ECG analysis (additional charges could occur for the owner/client at the referring veterinarian for recording of the ECG, material used, and discussion of the results):
NORMAL SERVICE: Report within 5 working days after checking payment is successful
EXPRESS SERVICE: Report within 2 working days after checking payment is successful
Working days do not include Sat, Sun, PH.

Please send us (a) This form (b) ECG and (c) Credit card payment form or bank in slip to info@cityuvmc.com.hk.
For direct bank transfer: Hang Seng Bank, Account No: 395-499379-883, Account Name: CityU Veterinary Health Group Co Ltd

Please also see CityU VMC ECG Guidelines to provide optimal quality for interpretation.

Appointment or Enquiry: 3650 3000 (Mon to Sun: 9:00am - 7:00pm)
24-Hour Emergency Hotline: 3650 3200
Location:	G/F-2/F, Trinity Towers, 339 Lai Chi Kok Road, Sham Shui Po, Kowloon, HK.
Main Entrance:	Junction between Lai Chi Kok Road and Kweilin Street, Sham Shui Po, Kowloon, HK.
ER Entrance:	202 Yee Kuk Street, Sham Shui Po, Kowloon, HK.
Wellness Services:	G/F, West Park, 256 Tung Chau Street, Sham Shui Po, Kowloon, HK.
Email:	(General Enquiries & Patient History): info@cityuvmc.com.hk
Fax:	2715 3490
WhatsApp:	(General Enquiries): 36503288 (Dispensing only): 6101 1026 Please text the details of enquiries with your name and contact number. (Text message only and please do not send voice messages or call)

General:	9:00am - 7:00pm
Emergency:	24 Hours

For Referring Clinics

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