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  • MSPCA-Angell Boston Clinic Referral Form

     
    MSPCA-Angell Boston Clinic
    350 South Huntington Ave.
    Boston, MA  02130
    Ph: 617-522-5055, ext. 5524
     
    The MSPCA-Angell Boston Clinic offers acute outpatient care to low-income clients on a referral basis. The clinic is best suited for acute care or outpatient surgical cases and cannot take on chronic cases/conditions. The clinic is equipped to treat dogs and cats for stable emergencies. The clinic is not equipped to handle time-sensitive emergencies in which the patient’s outcome would be negatively affected by a wait time (for example: complete urinary obstruction, bloat). Please note that the shelter is not staffed overnight, therefore we cannot offer 24-hour hospitalization. More information can be found at angell.org/clinics.
     
      REFERRING VETERINARIAN INFORMATION
    1. Please provide your information.

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    Name:

     

     

     

         

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      REFERRAL INFORMATION
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    Question - Not Required - Please check all that apply.

      CLIENT INFORMATION
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    *8.
    Question - Required - Is the client on any public assistance program? To receive care at an MSPCA-Angell Clinic the client must be on public assistance (listed below) or have an income under the MA poverty guidelines (aspe.hhs.gov/poverty-guidelines). Ultimate determination of suitability for this program will be made on a case-by-case basis at the discretion of MSPCA managers and veterinarians.
    Please make between 1 and 7 selections from the choices below.

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      PATIENT INFORMATION
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    MEDICAL HISTORY

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      After submitting this referral form, please forward medical records to clinic@mspca.org.
       Please leave this field empty