Referral Form

If you have any problems submitting the on-line form, please try a different browser. Google Chrome is the recommended one. If you should encounter ongoing problems, please consider using the downloadable editable pdf and let us know about any difficulties you're having.

To submit a referral please complete the form and press submit. You will then receive a confirmation e-mail and your request will be passed to the relevant department. Alternatively, you can download an editable pdf (see below) and email to us ( If sending this way, the recommended maximum information is 10MB (50MB using on-line form).

Please note: This form must be completed by the referring Veterinary Surgeon only.

Request for


Referring veterinary surgeon

Practice Address

Client details

Client's address

Patient details

DD slash MM slash YYYY

Insurance details

Case details

Service to be referred to(Required)
DD slash MM slash YYYY
Does this case need an urgent appointment?(Required)
Tests available
Please indicate which (if any) tests that are available and click 'Choose File' below to attached any supporting documents to your request. To add more documents, click the 'Add more attachments' link below.
Drop files here or
Max. file size: 100 MB.
    Is the client aware they will need to leave a deposit?(Required)