Refer a Case

Customer Notice

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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: 50 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: 50 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

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