Referral Form

Please note: This form must be completed by the referring Veterinary Surgeon only.

To submit a referral please complete the form and press submit.

You will then receive a confirmation e-mail and your request will be passed to the relevant department.

Our reception team will endeavour to make contact with your clients within the next five working days if your referral is routine.

Urgent referrals will be contacted ASAP.

If you do not receive a confirmation e-mail within a few minutes please check your junk or spam folders and mark the message as not spam to avoid problems receiving our correspondence in the future.

Referring veterinary surgeon

Practice Address*

Client details

Name*
Address*

Patient details

DD slash MM slash YYYY

Case details

Service to be referred to*
How soon does this case need to be seen?*
Diagnostics Performed
Please indicate which (if any) tests that are available and click 'Choose File' below to attached any supporting documents to your request.
Please attach all history, lab test results and xrays for your case.
Drop files here or
Max. file size: 20 MB.
    (Estimates for common conditions are available here or otherwise please call us on 01962 767920)
    Consent*
    You, as the treating Veterinary Surgeon, confirm that you have all necessary rights and legal bases, and/or have obtained consent, to collect and share the personal data of the Owner with Anderson Moores and the Linnaeus family of veterinary businesses for the purpose of veterinary treatment. You agree to indemnify Anderson Moores and the Linnaeus family of veterinary businesses in the event that you do not have the lawful rights to collect, use and share the personal data of the Owner.