Veterinary Referrals in Wales

Requirements

Please select the area most suited to your case:(Required)

If you have a patient that you would like to transfer to us for out of hours care, please follow the established process for this. If you have any queries please call the hospital on 02920 001 454 to speak with a member of the team. Please Note: All Hydrotherapy patients will have an initial assessment by our Physiotherapist.

CT Scanning Disclaimer

By choosing CT Scanning, we will organise for the patient to come to us for a CT scan of the specific area as instructed by you. The CT Report will be interpreted and returned to you to discuss next steps with the client. If you would like to refer the patient for a work up with an appropriate clinician, please select the appropriate clinical area from the options above.

Do You Want To Include Contrast?(Required)

For example, are you purely looking for orthopaedic issues e.g. joint dysplasia/fractures or are you concerned about inflammatory/neoplastic process which would warrant contrast.

Please Specify Any Questions To Be Addressed By The CT Scan(Required)

e.g. Is there evidence of elbow dysplasia? Is there evidence of metastatic disease in thorax?

Client Details

Telephone(Required)

Email(Required)

Patient Details

Name(Required)

Species(Required)

Breed(Required)

Weight(Required)

Date of birth(Required)

Colour

Gender and Neutering Status(Required)

Is the patient insured?(Required)

Insurance provider

Insurance policy number

Is the patient fit for travel?(Required)

Has the patient been imported or travelled outside of the UK?(Required)

Please specify the countries they have been imported from/visited

Patient cautions

Please provide a summary of patient's clinical history including duration of complaint(Required)

Patient History and Supporting Documents(Required)

Max. file size: 50 MB.

Imaging documents

Max. file size: 50 MB.

Lab results documents

Max. file size: 50 MB.

If your documents are located on a third-party system you must first download them to your device and then upload them to this form. Accepted formats: jpg, jpeg, png, gif, pdf, doc, docx, dcm, zip (8MB maximum). To send larger attachments, or if you experience problems uploading your documents via this form, please email (8MB max per email) to [email protected]. Please note: If you try to submit this form and fail to complete the fields correctly, you will need to re-attach the documents before re-submitting the form a second time.

Referring Vet Details

Practice name(Required)

Phone(Required)

Email(Required)

Other Information

Please tell us why you chose Valley Veterinary Hospital

Please add any additional notes here

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Referrals

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Requirements

CT Scanning Disclaimer

Client Details

Patient Details

Referring Vet Details

Other Information