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1800 North Sterling
Peoria, IL 61604

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(309) 672-1572

Call Us

309-672-1565

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Veterinarian Referrals

If you are a Veterinary Office referring a client to our clinic, please fill out the form below.

Patient Details

Owner Name *

Phone *

Address *

City *

Zipcode *

Patient Name *

Species

Canine Feline Other

Breed *

Weight *

Temp

Pulse

Resp

Referring Hospital

Referring Veterinarian

Diagnosis

Rule Outs

Diagnostics Performed

Bloodwork Urinalysis Radiographs Ultrasound

Pending Diagnostics

Treatments Performed

IV Fluid/Types

Rate: mL/hr

Medications Given Please indicate strength of medication. Tri-County may carry a different strength

Medication

Route

IV IM SC PO

Dose ( mg/kg )

Time Given

Medication

Route

IV IM SC PO

Dose ( mg/kg )

Time Given

X

Medication

Route

IV IM SC PO

Dose ( mg/kg )

Time Given

X

Medication

Route

IV IM SC PO

Dose ( mg/kg )

Time Given

X

Medication

Route

IV IM SC PO

Dose ( mg/kg )

Time Given

X

+ Add Another Medication Given

Treatments required at Tri-County

IV Fluid/Types

Rate: mL/hr

Medications Required Please indicate strength of medication. Tri-County may carry a different strength

Medication

Route

IV IM SC PO

Dose ( mg/kg )

Time Given

Medication

Route

IV IM SC PO

Dose ( mg/kg )

Time Given

Medication

Route

IV IM SC PO

Dose ( mg/kg )

Time Given

Medication

Route

IV IM SC PO

Dose ( mg/kg )

Time Given

Medication

Route

IV IM SC PO

Dose ( mg/kg )

Time Given

+ Add Another Medication Required

Special Instruction/Request

Offer Food

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Service Area

Providing emergency services in several cities including:

Peoria

Pekin

Bloomington

Normal

Macomb

Quad Cities

Galesburg

East Peoria

Kewanee

La Salle

Canton

Lewistown

Business Hours

Monday to Friday
5:30 PM to 8:00 AM

Saturday & Sunday
Open 24 Hours

Contact Information

Tri County Animal Emergency Clinic
1800 North Sterling Peoria, IL 61604

309-672-1565

(309) 672-1572

[email protected]

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