Referral Form

Referring Vet's Name*

First Last

Referring Vet's Practice*

Referring Vet's Email*

To which reports will be sent

Animal name

Client Name

First Last

Client's Primary Phone*

Client's Secondary Phone

Is Patient Insured?*

Yes

Insurance Company

We prefer to avoid direct insurance claims if possible but will consider if essential. A deposit of £250 is required for direct claims which will be refunded once the account has been fully settled. Please see our website for further details.

Brief summary of problem you would like investigated

Please upload a PDF of the pertinent clinical history

Drop files here or

Max. file size: 25 MB, Max. files: 9.

How urgently does this patient need to be seen?

Emergency (on the day) – please complete and submit this form and call us on 0141 2120321 to check availability.

Investigations Requested

*Please contact us for patient preparation instructions Feel free to contact us if you require an estimation of cost for other procedures not listed here (eg surgical ligation of patent ductus arteriosus). Please note that additional fees may be incurred if pathological samples are submitted to an external laboratory, in unforeseen circumstances (eg emergency situations) or if additional tests or procedures are performed after obtaining consent from the owner.

Total

Regarding ‘under our care’ policy: Patients are deemed under OUR care whilst within our premises. Once discharged from our premises, patients once again become ‘under the care’ of the referring veterinary practice. We will update the referring vet with our findings as soon as practical before or soon after discharge. We will email you copies of any reports that we subsequently receive (for example histopathology reports). As the referring vet, you will remain in charge of the ongoing care and management of the patient. Requests for ongoing support and case management must be made by the referring veterinary surgeons, and not the owners.

Any other information that you would like to add?

Feel free to contact us directly by phone or email to discuss.

Case Referral Form