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Refer A Case

Complete the form below

If you are a client looking for your pet to be referred. Please ask your current veterinary practice to complete this form on your behalf. 

 

Practice Details

Owner Details

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

 

Patient Details

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

 

Neutered:

Referral Details

Type of Referral*:
Discipline(s) to which you are referring*:
Infectious:
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.*:

Financial Details

Security Question:

 

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Company's registered name: Independent Vetcare Ltd
Registered number: 07746795 - Registered Address: Pinsent Masons LLP, 13 Queen’s Road, Aberdeen, AB15 4YL
Authorised and regulated by the Financial Conduct Authority for credit-related regulated activities under reference number: FRN738010