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Guide to Using Secondary Veterinary Hospitals (Referral Hospitals): When to Visit and How to Prepare

ImmunityQ&AMeongsiljang Veterinary Advisory Board

We’ve put together everything pet owners need to know about secondary veterinary hospitals (referral hospitals), including what they are, when to visit, the referral process, and what to prepare and expect in terms of costs.

What Is a Secondary Veterinary Hospital?

A pet owner and their dog waiting for a consultation in the lobby of a specialty animal hospital

A secondary veterinary hospital is a specialized facility that receives referrals from primary clinics (local neighborhood animal hospitals) when diagnosis or treatment proves challenging, providing advanced care. The key point to remember is that secondary hospitals operate on a referral and appointment basis, so walk-in visits often cannot be accommodated for same-day treatment. These facilities are equipped with advanced imaging technology such as MRI and CT scanners, and staffed by board-certified specialists in fields like internal medicine, surgery, neurology, and oncology.

When Should You Visit a Secondary Hospital?

We accept referrals from primary care veterinarians when the underlying cause remains unclear or when specialized equipment and surgical expertise are required. Typical scenarios include: - Symptoms of unknown origin: Neurological issues such as seizures or paralysis, which are difficult to diagnose without advanced evaluation. - Need for advanced imaging: Conditions like tumors or intervertebral disc disease that require MRI, CT, or contrast studies for accurate diagnosis. - Specialized surgery: High-complexity procedures such as cardiac surgery, laparoscopy, or orthopedic surgeries (e.g., TPLO). - Critical care management: Emergency situations requiring 24-hour intensive care, including oxygen therapy, mechanical ventilation, or dialysis.

How Do Primary and Secondary Hospitals Differ?

Let’s compare the differences at a glance. The two clinics are not in competition; they have a division of roles.

Primary vs. Secondary Hospital Comparison

Item	Primary Veterinary Clinic	Secondary (Referral) Veterinary Hospital
Role	Primary care · vaccinations · basic tests	Specialty care · advanced diagnostics · complex surgery
Visit Method	Walk-in available	Appointment · referral letter required
Main Equipment	General X-ray, ultrasound	CT, endoscopy, and other advanced diagnostic equipment
Veterinary Staff	General veterinarians	Specialists in internal medicine, surgery, neurology, etc.
Average Cost	Relatively low	Higher due to specialty care and advanced diagnostics

This varies by hospital and depends on the specific services.

How Does the Referral Process Work?

It is standard practice to have your primary care veterinarian refer you rather than making the decision on your own. The process unfolds as follows: 1. Visit your primary clinic for an initial examination, where the need for secondary care is assessed. 2. Your veterinarian prepares a referral letter along with imaging and test records. 3. Schedule an appointment at the secondary hospital (you will need to call and book this directly). 4. Visit the secondary hospital for advanced diagnostics and to establish a treatment plan. 5. Return to your primary clinic for ongoing management after treatment. This workflow is known as a "refer-back" system.

The pet owner handing over the referral form and video CD

Pre-Visit Preparation Checklist

Secondary care clinics rely on your pet’s existing medical records to avoid starting all over with tests. Missing documents can lead to duplicate testing, which increases both cost and time. - Referral letter: A summary of the primary clinic’s diagnosis and the reason for referral - Imaging files: X-ray, ultrasound, or CT scans (on CD or via a cloud link) - Blood test results: The most recent lab report (please bring the latest available) - Medication history: Names, dosages, and duration of any current medications - Vaccination and heartworm prevention records: Vaccination booklet or copies - Owner’s ID and payment card: For identity verification and payment

When You Can Go Directly Without a Referral

While we generally operate on a referral basis, in clear emergencies, you should not waste time going through a primary care clinic first. If your pet is experiencing difficulty breathing, persistent seizures, severe bleeding, decreased consciousness, or abdominal distension accompanied by unproductive retching, you should go directly to a 24-hour emergency-capable secondary hospital or an animal emergency center. Calling ahead to provide your estimated arrival time and describe the symptoms will allow treatment to begin immediately upon your arrival.

How Much Does It Cost?

Costs at specialty veterinary hospitals can vary significantly depending on the clinic, location, and specific tests required. Here’s a general estimate to help you plan: - Initial consultation fee: $40 to $100 - CT scan: $400 to $900 - MRI scan: $900 to $2,000 - Orthopedic surgery (e.g., TPLO): $3,000 to $6,000 - Hospitalization (per day): $70 to $200 For any costs not listed here, be sure to confirm directly with the clinic. Requesting a detailed estimate in advance can help you prepare your budget more effectively.

A veterinary clinic staff member explaining the estimate for treatment costs.

Key Points to Keep in Mind When Using a Secondary Hospital

Specialized care often involves multiple treatment options. When choices arise—such as surgery versus medical management, or aggressive treatment versus palliative care—it’s important to discuss the prognosis, potential side effects, and costs of each option before making a decision. Additionally, it’s common to return to your primary care veterinarian for ongoing long-term management after completing treatment at a specialty hospital. Maintaining continuity with your primary vet is generally better for your pet’s health.

Reviewed by a veterinarian

Dr. Tony — Punnawat Phongkittirak

Veterinarian

A veterinarian who majored in veterinary medicine at Khon Kaen University, Thailand, and completed the IVSA program at North Carolina State University in the United States. Drawing on clinical experience at animal hospitals, he works in the pet healthcare field and is dedicated to building a digital care environment that connects pet parents with veterinarians.

Frequently Asked Questions

If I go to a secondary hospital without a referral, will I not be able to receive treatment at all?

In emergencies or at certain clinics, you may be able to proceed without a referral. However, if you don’t have prior test records, the clinic will need to start all tests from scratch, which can increase both time and cost. Whenever possible, we recommend obtaining a referral letter and imaging results from your primary care vet before visiting.

After completing treatment at the secondary care hospital, do I need to return to the primary care clinic?

Yes, that’s typically how it works. For long-term medication, rehabilitation, and daily care, it’s more efficient to continue treatment at a primary care clinic that’s convenient for you. Secondary care hospitals maintain continuity of care by providing detailed management instructions to the primary clinic after diagnosis, surgery, or intensive treatment.

Are university veterinary hospitals also considered secondary care facilities?

Veterinary teaching hospitals are a prime example of specialized referral centers. However, the veterinary field still lacks a standardized classification system that officially distinguishes hospital tiers (primary, secondary, and tertiary). In cases involving rare diseases, complex surgeries, or clinical research, general specialty referral hospitals may further refer cases to university-affiliated veterinary teaching hospitals.

Does pet insurance also cover secondary hospital costs?

Coverage varies by insurer and policy. While most policies include any licensed veterinary clinic, high-cost services such as surgical riders, MRI, and CT scans often have separate coverage limits or deductibles. Be sure to confirm with your insurance provider which items are covered before your visit.

How long does it take to schedule a second-opinion appointment?

Wait times for general outpatient appointments are typically one to three weeks, while specialized departments such as orthopedics and neurosurgery may have wait times of one to two months. In case of an emergency, you can go directly to the emergency room on the same day, so please confirm with your primary veterinarian whether an emergency referral is necessary.

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References

[1] Silverstein D, Hopper K, Small Animal Critical Care Medicine, 3rd Ed, Elsevier, 2022

[2] Campoy L, Read M, Small Animal Regional Anesthesia and Analgesia, 2nd Edition, Wiley-Blackwell, 2023

[3] Burkitt Creedon JM, Davis H, Advanced Monitoring for Small Animal Emergency and Critical Care, 2nd Ed, Wiley-Blackwell, 2023