Referral Form

Use this form to refer a pet to our team and provide the key details we need. Once submitted, we’ll review the information and call you promptly to discuss the next steps and arrange an appointment.

Referrals contact form for Veterinary Surgeons

Practice Details

Referring Practice *
Referring Vet *
Practice Contact Number *
Practice Contact Email *

Client Details

Client Name *
Client House Number, Street Name *
Client City, Town *
Client Postcode *
Client Phone Number *
Client Email *

Patient Details

Patient Name *
Species *
Breed *
Age *
Sex *
Is the pet imported from another country? *

Reason for Referral *
Any other underlying health concerns *
Patient's current medication *

Please upload the patient's clinical history
Please upload any x-rays
Please upload any relevant blood results or other lab work
Please upload any other relevant information e.g. photos, ultrasound images

Referral Form

Referrals contact form for Veterinary Surgeons

Practice Details

Client Details

Patient Details

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Potter House Vets