Vet Professionals Refer a Case How to Refer Emergency Cases Request Advice CPD Vet Club Nurse Club Residency Programme Internships Fixed Prices Orthopaedics Veterinary surgeons only Refer a Case Emergency Cases Refer a Case Please complete the online referral form below. For emergency cases, please phone us on 01928 711400 1Vet Practice Details2Pet Owner Details3Patient Details4Investigations to Date Service required(Required)Internal MedicineOncologyNeurology/NeurosurgeryPain Management ClinicOrthopaedic SurgerySoft Tissue SurgeryPhysiotherapyVet Practice DetailsReferring Vet Name(Required) Address(Required) Address City Postcode Telephone Number(Required)Mobile NumberEmail(Required) Preferred contact for reports(Required) Email Post Name(Required) Address(Required) Street Address City Postcode Telephone Number(Required)Mobile numberEmail(Required) Insured?(Required) Yes No Insured with which company?(Required) Name(Required) Age/DOB(Required) Sex(Required) Male Female Neutered Breed(Required) Species(Required) Brief summary of presenting complaint/reason for referral(Required) X-rays(Required) Yes No Emailed ECG(Required) Yes No Emailed Urine analysis(Required) Yes No Emailed CT/MRI(Required) Yes No Emailed Ultrasound(Required) Yes No Emailed Other laboratory results Full clinical history will be:(Required)Attached to formEmailed (to [email protected])Attachments(Required)Max. file size: 20 MB.Upload full clinical historyCurrent medical treatments/medicationsHas the dog travelled abroad in the past 5 years, and if so, where?Consent I agreeBy submitting this form to Northwest Veterinary Specialists (“NWVS”), I/we confirm that I/we have express consent from the individual(s) concerned to transfer the personal data set out in this form to NWVS.