Online Referral Form

Veterinary surgeons wishing to discuss a case or arrange a referral, complete the form below or to discuss a referral please call our main hospital number 01608 642547

If the case is urgent, call us!

Our Expert Exotics Vets

Nathalie Wissink-Argilaga
CertAVP(ZM), DZM(Reptilian), MRCVS, RCVS Specialist in Zoo & Wildlife Medicine

Martin Whitehead
BSc, PhD, BVSc, CertSAM, MRCVS

Peter Kettlewell
MA, BVSc, MRCVS

Referring Vet Details

Name of Referring Vet*:

Name of Referring Practice*:

Practice Email*:

Practice Telephone Number*:

Client Details

Client Title*:

Client First Name*:

Client Surname*:

Client Address Line 1*:

Client Address Line 2:

Client City*:

Client Postcode*:

Client Home Telephone Number*:

Client Mobile Number:

Client Email:

Patient's Details

Patient Name*:

Patient Species*:

Patient Age*:

Patient Gender*:

Referral

What type of animal is the referral for?:

Please provide brief outline of the reason for referral (max 3000 characters):

More detailed information can be uploaded in the Attachments section.

Attachments

Please attach the appropriate case history and any additional records e.g. test results (Max total file size 8MB).

Attach Animal History*:

Attach Animal History:

Additional Information:

I have read and agreed to the privacy notice:

Security Question:

Online Referral Form

If the case is urgent, call us!

Referring Vet Details

Client Details

Patient's Details

Referral

Attachments

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