Refer a Case

Referrals to one of our specialists can be arranged by phone, fax or e-mail. Consultations are carried out Monday to Friday depending on which service is required.

To arrange a referral appointment for your client or for advice on a case, please contact the clinic on 01494 875875 alternatively fax or email a referral form. We will contact your client directly to arrange an appointment. If you prefer us not to do this please indicate this on the referral form. We will advise you of the client’s appointment and request any history and x-rays. You can send these to us via the link below or e-mail/fax them to us at info@chilternreferrals.com

Please phone 01494 875875 if you have an urgent referral. Please do not fax or email urgent cases.

If you prefer, you can download a copy of our referral form.

Need to send us files without filling in the form? Click here.

Service:* Please indicate the service(s) for which you wish to refer	Orthopaedics Dermatology Soft tissue surgery MRI Physiotherapy Neurology
Appointment Required:*	Select Option As soon as available Within 7 days Urgently, within 24 hours
Details of referring Veterinary Surgeon and Practice:
Name of Veterinary Surgeon:*
Practice Name:*
Practice Address:*
Telephone:*
Fax:
E-mail Address:*
Client details:
Title:* Mr/Miss/Ms/Mrs etc.
Initial:*
Surname:*
Client Address:*
Telephone:*
Mobile:
E-mail:*
Patient Details:
Name:*
Species:*
Breed:*
Sex:*	Male Female
Neutered:
DOB/Age:*
Colour:*
Weight (kgs):
Insured?:
Insurance Company:*
Presenting Problem/Brief clinical history:*
If you need to upload any supporting files (such as X-Ray images or case history/notes), you will be able to do so in the next step.