Forms

Referral Form

FOR VETERINARY SURGEONS ONLY

If you think your case is an emergency, please contact the surgery BEFORE sending this form.

Failure to contact us regarding an emergency case may result in the referral not being processed urgently.

Animals need to be referred to us via the first opinion vet. We regret that we cannot accept referral forms from pet owners directly.

A downloadable PDF of the referral form is available by clicking here.
If you require case advice only, click here.

ALL sections of the referral form MUST be completed. Incomplete referrals will not be processed.
Comments such as ‘see history’ will not be accepted and returned to you for completion.

Please attach a full history including blood results
or email them to admin@eye-vet.co.uk

Client Information

Name(Required)
Address(Required)

Animal Information

Date of Birth
Insurance(Required)

Practice Information

Conditions

Priority(Required)
Emergency - You MUST call the practice before sending this online referral form as this is deemed an emergency. Low Priority - Will be seen within 1-2 weeks
Tick all relevant conditions(Required)

Medical Details

Comments such as 'see history' will not be accepted and returned to you for completion
Max. file size: 8 MB.
By submitting this referral request I:
and I: