Referral form

Leeds Birstall Small Animal Hospital Referrals
If you wish to refer a patient to the Leeds Birstall Hospital for treatment, please complete the form below. If your referral is urgent, or involves the transfer of a hospitalised patient, or you require advice regarding a current case please contact the practice on 01924 441144.

Once we have received your referral form, we will contact the client to organise an appointment. Please note our normal working hours for this service are Monday to Friday, 8am to 6pm. Any referrals sent beyond these hours will be dealt with on the next working day.

For all referrals, please complete the booking form with your client’s details Please attach all clinical history along with any blood test results or radiographs for the clinical team to assess.
Referral to which department
Referring Practice
Referring Vet
Contact Phone Number
Patient details
Patient Name*

Pet NameClient Surname
Client House Number and Postcode
E-mail
Phone Number
Client Phone Number
Reason for referral
Reason for Referral
Please briefly describe the nature of the referral and what you expected treatment course may be.
Other Information
Continual Treatment Plan

Birstall to do Diagnostic Imaging and Home Practice to Perform TreatmentBirstall to do Diagnostic Imaging and to Perform Treatment
Please click 'Browse' and upload clinical history and any clinical documents required

Choose File

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CT Referrals Only

If you have requested a CT Scan, we require this form to be filled in also for the CT Company. Please download and email a copy to referrals.leedsbirstall@vet4pets.com
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Leeds Birstall Small Animal Hospital Referrals

CT Referrals Only