Referral Form

Please provide us details about the case you are referring. We aim to triage cases as soon as we receive them, and organise an appointment pertinent to the condition and patient status. It is helpful to have as much information as possible to assist this process.

Current wait times for appointments are:

Emergencies
Usually same day
Please phone directly 01483 668100

Urgent cases
70% within 2 days

Routine cases
5 days

Referral Form

How urgent is your referral?

For emergencies, please phone 01483 668100 (available 24/7, 365 days) to discuss this case with the on-call emergency veterinarian

Practice Name

Practice Address 1

Practice Address 2

Practice Address 3

Practice Town

Practice Postcode

Practice Email

Practice Phone Number

Your First Name

Your Last Name

Best contact number for you (next 24 hours)

Client Title

Client First Name

Client Last Name

Client Address 1

Client Address 2

Client Address 3

Client Town

Client Postcode

Client Email

Client Phone Number

Patient Name

Species

Breed

Sex

Date of birth

Reason for referral

Please upload copies of clinical records, images, xrays etc

Choose File

Does the patient have other conditions currently under treatment?

Yes

Briefly describe what other clinical conditions is the patient being treated for?

Is the patient fit to travel?

Is the patient insured?