• Reason for referral
• Service to be referred to
• History/referral request
• Does this case need to be seen in the next 7 days? (please note, if this is an emergency and needs to be seen in the next 24-48 hours please telephone us) No Yes
• Available test results
  • Radiographs
  • Blood results
  • Urinalysis
  • ECG
  • Ultrasound
  • Biopsy/histopathology results
  • Other Laboratory results
• Have we given you an estimate, and if so what was it?
• Is the owner aware of potential costs, and the need to leave a deposit prior to any treatment? No Yes

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