SouthEast Vet Referrals

Make a Referral

Medicine

"*" indicates required fields

1Owner

2Patient

3Referral

4Practice

Owner's Details

Name*

Prefix First Last

Address*

Post code

Select an Address:

Street Address Address Line 2 City Country

Mobile Phone*

Home phone

Email address*

Patient details

Name*

Species*

Breed

Date of birth*

Gender / Neutering status*

Patient behaviour

Has the patient travelled outside the UK?

Yes

Brucella canis testing is required before we can accept this patient

Unless this patient has only ever been in the UK, Ireland, Denmark, Norway, Sweden, Finland, Germany, Belgium, France or Switzerland, we cannot accept the referral until Brucella canis testing has been completed and the result is back.

Please check the requirements before going any further. If testing has not been done, call us on 01732 228604 and we will talk the case through rather than you completing this form.

Read the Brucella canis testing policy

Referral

Reason for referral and case summary*

Does the patient have any other conditions currently requiring treatment/ and or regular monitoring?

Clinical history

Drop files here or

Accepted file types: doc, docx, pdf, jpg, jpeg, png, Max. file size: 8 MB.

Please indicate which documents/ diagnostics are available to support the referral?

Clinical history

Bloods

Radiographs

Other reports

Practice name:*

Practice address:*

ZIP / Postal Code

Select an Address:

Street Address Address Line 2 City State / Province / Region

Vet name:*

Vet Name*

Prefix First Last

Vet email:*

Vet mobile number

(if happy to receive updates/report via WhatsApp)

Practice phone number:*

Updates from South East Vet Referrals

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