• CT SERVICE REFERRAL FORM

    CT SERVICE REFERRAL FORM

    Urgent Case? Telephone us on 01507 609 929 to speak to a clinician
  • Please choose appointment type:

  • Referring Veterinary Surgeon Details (About You)

  • PREFERRED CONTACT METHOD(S):

  • Owner's Information

  • Patient Details

  • SPECIES:
  • SEX:
  • NEUTERED:

  • Reason for Referral

  • Please indicate preference for making this appointment:
  • DIAGNOSTIC IMAGES:
  • Upload up to 8 Files
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  • EXISTING LAB RESULTS:
  • Upload up to 5 Files
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  • Upload up to 2 Files
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  • * For all cases, please attach the referral letter with any recent treatments, and copies of any diagnostic tests.

  • Data Protection: We will use the personal information you give us exclusively for the purposes of referring a case to us. We will not pass on any of your details to any outside organisations or individuals unless with your express consent. Please see our Privacy Policy

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