Refer a Case

Customer Notice

Rob is away from Friday 10th July to Tuesday 28th July. We cannot accept urgent referrals during this period.

On completion of the form, you will receive a confirmation email. If you do not receive the email, we have not received your request.

Image files should be in JPEG format. (.zip files cannot be attached.)

Thank you.

Appointment Type or Priority*

Urgent

Routine

Client Details

Owner's Name*

Owner’s Home Telephone

Owner’s Mobile Number*

Owner’s Email*

Patient Details

Pet's Name*

Species*

Breed*

Weight*

Age (yrs)

Sex*

Has the patient been imported or travelled outside of the UK?*

Yes

Summary of Patient's Clinical History*

Specific symptoms (Limb(s) affected); Onset (per-acute/acute/chronic) (known Trauma); any concurrent disease; main findings on clinical examination; any tests already conducted (bloodwork, imaging); response to medication/any current relevant medication; main differential diagnoses.

Documents

Imaging Documents (X-rays, CT Report)

Drop files here or

Max. file size: 98 MB.

(JPEG, PNG and PDF files only, ZIP Files cannot be uploaded)
(Physical L/R markers and a calibrated marker are required if image is to be used for surgical planning)

Patient Documents (History, Previous Referral Reports etc)

Drop files here or

Max. file size: 98 MB.

(JPEG, PNG, PDF files only, ZIP Files cannot be uploaded)

Case Vet Details

Case Vet Full Name*

Practice Name*

Practice Postcode*

Case Vet Email*

Case Vet Phone Number*

Preferred dates or timings or any dates the client is unavailable

CAPTCHA