Client Self-Referral

Client Referral Policy

At Petderm, we understand you may be struggling to find the help you need for your special pet. We want to help you so we created a Self-Referral process. Traditionally, we have asked your family veterinarian to complete a referral to provide us the most detailed picture of your pet’s health. If you are self-referring your pet, we ask you to fill out the form with as much detail as possible and request your pet’s medical records from all previously known veterinarian visits to

We will do our best to treat your pet for their skin, allergy or ear condition, but routine veterinary services must continue through your family veterinarian.

We ask that you wait to do a biopsy or allergy test, and allow the Petderm team to assess the patient first, as it gives us the best chance to help your client and their pet.

In order to provide the best care possible, we ask that all referrals are done online through our website. If you are having any difficulty with this or you need to source an alternative way to refer, please contact our office at 403 370 8800.

    Owner Information

    Last Name*

    First Name*

    Cell Number*

    Home Number

    Email Address*

    Home Address

    Street Address*

    Address Line 2



    Postal Code*

    Pet Information







    Pet Birthdate


    Family Vet Information

    Current Clinic*

    Current Veterinarian

    Phone Number


    Has this client been to any other veterinary clinics?*

    Medical History

    Reason for Referral*

    How long has the problem been going on?*

    Relevant dermatological history* (i.e. chronic ear infections, inflamed, itchy skin, lumps and bumps, missing fur, etc.)

    Have you done any previous allergy testing, treatment of skin or ears?*

    Any other health issues not dermatology related?*

    Relevant diet history/information* (i.e. changes in appetite, vomiting, loose or runny stool, etc.)

    Is the pet on ectoparasite/endoparasite controls?*

    Please list all diagnostic tests performed*

    Additional Information

    Additional comments and / or concerns
    If your pet is in need of an urgent consult (i.e. in an active flare or active infection) Petderm offers emergency drop-off consults for an additional fee. Please explain if you need an emergency drop-off consult. (If your inquiry is urgent, please call the clinic at 403-370-8800 or visit a local hospital for emergency care.

    Relevant Images of Skin or PDF Medical History

    Files must be smaller than 5mb. If your file is larger than 5mb, please email it directly to

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