Vet Referral Internal Form

This form is for Vetlife veterinarians to complete an internal referral request. Upon completion, your request will be sent to the relevant clinic depending on the nature of your inquiry. We will endeavour to reply as soon as possible within normal working hours.

For emergency referrals, please contact your nearest Vetlife clinic directly.

If you are a veterinarian from a different practice, please complete this form instead.

Internal veterinary referral - online submission

Referral type

Orthopaedic
Ultrasound/imagery & radiology
Dental restoration
Rehabilitation
Hydrotherapy
Chiropractic
Acupuncture

Referring Vetlife veterinarian details

Client (owner) details

Name
Name
First
Last
Address
Address
City
District
Postal

Patient details

Client name
Client name
First
Last
Please supply a brief summary of the injury/surgery/condition.
Please detail any current medications or supplements.
e.g. Drug reactions, behaviour, allergies etc

Please note:

  • All corresponding documents to be uploaded with form submissions and saved with the date created.
  • Both DCM and JPG formats required for x-rays to enable measurements.
  • All orthopaedic surgery referrals require orthogonal x-rays prior to surgery.

Maximum file size: 262.14MB

Please upload all relevant clinical files (DICOM images will require compression) etc.


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