Referral form

For urgent referrals please contact PetMedics on 0161 794 4999.

We accept cases in CT, dentistry, medicine and surgery.

Please complete the referral form below for all non-urgent referrals. If you wish to send attachments via email rather than upload in the form please email them to referrals@petmedics.co.uk.

This referral form is monitored between 9am to 5pm, Monday to Friday. We will be in touch as soon as we have successfully booked your client in for an appointment to see a member of our team.

Is this case**
Referral request**

Referring vet details
Referring vet*
Practice name*
Practice address**
Contact telephone*
Fax
Email*
Are you a CVS practice?**

Owners details
Title*
Owner's first name*
Owner's surname*
First address line*
Second address line
Postcode*
Owner's email*
Owner's contact telephone*
Patient details
Name*
Breed*
Species*
Gender & neutered*
Date of birth*
Weight (Kg)*
Insurance company

Outline of problem/Reason for referral*
Current medication*
Documentation
Please attach 12 months clinical history including the results of any blood and urine tests performed.

Where possible please send radiographs in a digital format.
Drop files here or

Accepted file types: jpg, gif, png, pdf, docx, doc.
Data Protection: We will use the personal information you give us exclusively for the purposes of referrals. We will not pass on any of your details to any outside organisations or individuals unless with your express consent.

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