For veterinarians

Please fill out the following referral form, including as much information as you think is necessary about your patient.

After each session with your patient, expect to receive a document in SOAP format about the session to keep in your records.

I am happy to schedule a phone call or meet you in person should you have specific concerns.

CREDENTIALS DISCLAIMER: the acronym “VTS” on the company's name does NOT refer to a Veterinary Technician Specialty, in the field of rehabilitation or any other field, but serves as a legal distinction and refers to services provided by an active licensed veterinary technician in the state of Texas.

REFERRAL: With the submission of this form, the attending veterinarian agrees to refer the enlisted client to Corina Portillo, providing general supervision, for the purposes of starting physical rehabilitation after a differential/diagnosis has been reached. Should a concern/complication arise during the treatment plan, the patient will be referred back to the attending veterinarian for a reassesment.

Pet Owner

First Name

Last Name

Pet's Name & Signalment

Pet Owner's Phone / Email

Your client's preferred communication method

Referring Veterinarian & Contact Info

I will send sessions' notes to the email address provided here

Diagnosis / Differential Diagnosis

What are we rehabing? What is our goal?

Any Precautions I Should Be Aware Of?

Additional systemic/chronic disease, food restrictions, extreme discomfort, temperament

Moving is living, let's keep pets doing so

For veterinarians