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Southern Counties Veterinary Specialists 01425 485615
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COVID-19 update: Client advice on what to do during the Coronavirus crisis

Standard Referral

Complete R1 form below

Standard Referral

Complete R1 form below

Referral Request Form

To submit a referral please complete the form below and press submit. Your client will be contacted to book an appointment by our referral department.

Owners are reminded that referrals must come from your primary care veterinary centre, we can not see patients unless referred to us by a veterinary surgeon.

For emergencies please call 01425 485613 before submitting this form.

 

Practice Details

Owner Details

Please leave non-mandatory fields if they are in the patient history.

 

Patient Details

Please leave non-mandatory fields if they are in the patient history.

 

Neutered

Referral Details

Type of Referral*

Discipline(s) to which you are referring*







Infectious

What diagnostics have previously been performed? (Please include results/images - Dicom images can be sent using our FTP server) Please call for instructions if you are not signed up to use our FTP server.*







Financial Details

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