Refer to UVTHS

Referral to the University Veterinary Teaching Hospital Sydney

Thank you for choosing The Sydney University Veterinary Teaching Hospital referral service.

On completion of this form, your client will receive notification of the referral request including the reason for referral field and details on how to contact us to arrange a booking.

I would like to refer to - Department
Department*

Introducing - Client/Patient Details
Client Name*

First NameLast Name
Client Mobile Number*
Client E-mail*
Patient Name*
Patient Breed*
Patient date of birth*

MonthDayYear
Date
Sex*

FemaleFemale neuteredMaleMale NeuteredOther
Has {patientName} been seen previously by the team at UVTHS?

YesNo

Referred By - Vet name and Clinic details
Clinic Name*
Vet Name*
Referring Vet - Preferred Email Address*

Case History
Reason for referral (Client Information)*
Brief description/Comments - Duration of illness, signs observed, assessment, medical/surgical management and response. *
Please attach patients full medical record*

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Please attach pathology results

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Please attach radiographs

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Other

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Should be Empty: