Online Submission of Referral Information

Christmas & New Years Holidays!

Please note that Veterinary Referral Services will be closed from the 18th of December and will re-open on the 5th of January.

If you wish to refer a patient for cruciate surgery, please note that alternative availability may be arranged with Dr Paul Eason at FVS Pukekohe – (Call on 09 238 7486 or email [email protected]

Thank you for your support through out the year and we hope that everyone has a safe and happy holiday!

Veterinary Referral Services - Online Submission

Clinic Details

Please indicate if this is a Referral or Case Review(Required)

Referral

Case Review

Would you like to mark as Urgent?(Required)

Yes

My Vet Clinic(Required)

Clinic Phone Number(Required)

Clinic Email(Required)

Primary Veterinarian(Required)

Veterinarian Phone Number

Veterinarian Email

Owner Details

Name(Required)

First Last

Owners Phone Number 1(Required)

Owners Phone Number 2

Owners Email(Required)

Patient Details

Patients Name(Required)

Breed(Required)

Reason for Referral(Required)

• Please upload clinical files, imaging and lab results (or link to images can be posted in general comments section)(Required)

Drop files here or

Max. file size: 1 GB.

General Comments

Patient Special Considerations

e.g. Drug reactions, behaviour, allergies etc

Online Submission of Referral Information

Christmas & New Years Holidays!

Veterinary Referral Services - Online Submission

Clinic Details

Owner Details

Patient Details

Veterinary Referral Services

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