Refer a Patient

Long Beach Animal Emergency provides our forms online so that you can fill them out in the comfort of your own home and at your convenience. You can either complete and submit the form on our website, or you can download the fill-able PDF to complete and bring with you to our hospital.

Important: To complete the fill-able PDF on your computer, follow these steps:

  1. First DOWNLOAD the PDF to your computer
  2. Open downloaded PDF and fill in all fields
  3. Save completed form
  4. Submit using the “online form submission” on this page

adobe-readerIf you would like to download the PDF, and do not already have AdobeReader® installed on your computer, click HERE to download.

Patient Referral Form – Download PDF | Complete Form Online

Online Form Submission

Your Name (required)

Your Email (required)

Your Phone

1.) Download form to computer/device
2.) Complete form and save completed version
3.) Click "Choose File" below & attach your completed form
4.) Click "Send"