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Complete the form below

If you are a client looking for your pet to be referred to Aberdeen Veterinary Referrals, please ask your current veterinary practice to complete this form on your behalf.

Practice Details

Veterinary Surgeon*:

Practice*:

City*:

Postcode*:

Phone Number*:

Email*:

Owner Details

Please leave non-mandatory fields if they are in the patient history.

Title:

First Name or Initial*:

Surname*:

Address Line 1:

Address Line 2:

Address Line 3:

City:

County:

Postcode:

Telephone Number*:

Mobile Number*:

Patient Details

Please leave non-mandatory fields if they are in the patient history.

Pet Name*:

Species:

Sex:

Neutered:

Yes
No

Breed:

Age:

Colour:

Referral Details

Type of Referral*:

Non-urgent Appointment (Next Available Appointment)
Urgent Appointment (Within 5 Working Days)

Discipline(s) to which you are referring*:

Internal Medicine
Orthopaedic Surgery
Soft Tissue Surgery
Neurology/Neurosurgery
Oncology

Infectious:

Yes
No

Brief summary of problem/reason for referral (Please always provide the full clinical history, lab results & any imaging relevant to the referral)*:

What diagnostics have previously been performed? (Please include results/images - Dicom images can be sent using our FTP server) Please call for instructions if you are not signed up to use our FTP server.*:

Blood Tests
X-rays
CT
Ultrasound
MRI
ECG
Other (please specify below)
None

Attach History:

Please specify:

Attach a File:

Attach a File:

Attach a File:

Attach a File:

Attach a File:

Attach a File:

Financial Details

Insured?:

Insurance Company:

Total amount being claimed by your practice:

Security Question:

Select a surgery:

I have read and agreed to the privacy notice:

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Company's registered name: Independent Vetcare Ltd

Registered number: 07746795

Registered Address: The Chocolate Factory, Keynsham, Bristol BS31 2AU

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