New Veterinary Referral Form

At Butterwick Animal Rehab, we know how much your patients mean to you, and we're honoured to support their care. Every dog we see is treated with the same dedication and compassion you would give.

We’ll keep you updated on progress and work closely with you and the owner throughout the rehabilitation process.

Other Vets told us they want:

A safe pair of hands for the rehabilitation of their patients
A qualified practitioner to whom they can refer their patients for veterinary physiotherapy and or hydrotherapy or the potential for this to help a case
Consistent and positive results
A one stop shop for rehab
A smooth easy referral system
Kept up to date on their patients progress
Reassurance that if we become aware of any issues that your patients are referred back to you for investigation by you

* Medical issues – if an owner informs us of a medical issue that we believe you are not/or should be aware of we will refer them back to you. This allows us to focus on our speciality which involves biomechanics, therapeutic modalities, manual therapy, home exercise plans to maximise positive results and leave the medical and surgical aspects to you.

Referring Veterinary Surgeon

First NameLast Name

Practice Name

Practice Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email (practice email or Surgeons)

example@example.com

Practice Phone Number (no gaps)

Please enter a valid phone number.

Client's Name

First NameLast Name

Client Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Client Phone Number

Please enter a valid phone number.

Client Email

example@example.com

GDPR consent

I confirm that the client has given permission for this referral and for their information to be shared with Butterwick Animal Rehab in accordance with GDPR.

Patient Name

Breed

Date of Birth

Date

Gender

Female EntireFemale NeuteredMale EntireMale Neutered

Are there any behavioural concerns

YesNo

If Yes, please describe:

Patient History summary

Upload patient history files:

I confirm that I have personally examined the above-named dog at rest and can see no contraindication to undertaking physiotherapy, controlled exercise, or manual therapies as appropriate.

While I have not formally assessed the dog's cardiovascular fitness for hydrotherapy or swimming, I am satisfied there is no clinical reason to withhold this treatment.

I confirm that I have obtained the owner’s consent to share relevant medical information with Butterwick Animal Rehab.

I remain responsible for the ongoing medical care and any emergency or out-of-hours provision under RCVS guidance.

**Please note that Butterwick Animal Rehab is not a first-opinion or emergency veterinary provider.**

Responsibility for all medical care, emergency treatment, and out-of-hours provision remains with the referring veterinary surgeon in accordance with RCVS 'Under Care' guidance.

We are happy to collaborate with you on any changes to the rehab plan if a patient’s medical status changes and will refer back to you if we have any concerns at any point.

Signature

Print name

If you need to send additional documents, you can email us at info@butterwickanimalrehab.co.uk

We’re always happy to discuss cases or tailor care plans.

Date

How did you hear about us?

Thank you for your referral — we truly appreciate your trust.

At Butterwick Animal Rehab, we know how much your patients mean to you, and we're honoured to support their care. Every dog we see is treated with the same dedication and compassion you would give.

We’ll keep you updated on progress and work closely with you and the owner throughout the rehabilitation process.

Thank you again for choosing to work with us — it genuinely means a lot.

Butterwick Animal Rehab Clinic