Book CT outpatient referral Please use the form below to use our outpatient CT services (Referring Veterinary Surgeons Only). Alternatively this form can be downloaded HERE and faxed or emailed to us. Please enable JavaScript in your browser to complete this form.Practice Details *Practice Name *Practice Postcode *Telephone Number *Fax NumberPractice Email Address *Client Details *Client AddressClient Telephone *Client MobileClient Email *Animal Details *Species *Weight *Sex *Neutered?YesNoAge *Insurance CompanyPolicy NumberReason for outpatient CT *Brief history and questions to be answered *Lab Results (if relevant)Has blood testing been performed within the last two weeks?YesNoContrast Required?YesNoIf uncertain, please contact us for advice.Would you like to speak to one of our Vets before we arrange the appointment with the client?YesNoHow would you like to receive your report?FaxEmailPostWould you like us to invoice you (the referring practice) directly?YesNoPlease note that if you would like us to acquire payment directly from the client we require payment in full on the day of scanning.CommentSubmit
