Winterley Clinic 01270 765555
Elworth Clinic 01270765555

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Referral Form

If your referral is urgent please call us on 01270 765555 Option 1.

Practice Details

Client Details

Patient Details

Is the animal insured?:

Please ask the client to contact the insurer to allow us to communicate with the insurer directly.

Referral Details

Service Required:


Please attach the appropriate case history and any additional records e.g. test results, radiographs, ECG tracings etc (Max total file size 8MB). Clinical history must be included.

For CT only

A contrast agent is typically used when scanning which is off licence. This will be discussed on the day.

Does your pet have any of the following?:

Please select areas for scanning:

Security Question:

It is the responsibility of the referring practice to send up to date history and relevant lab work prior to the patient being seen.