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Online Referral Form

Book CT Outpatient Referral

Please use the form below to use our outpatient CT services (Referring Veterinary Surgeons Only).

 

Referring Vet Details

Client Details

Pet's Details

Neutered?:

Insurance

Is the animal insured?:

Has blood testing been performed within the last two weeks?:

Contrast Required? If uncertain, please contact us for advice.:

Would you like to speak to one of our Vets before we arrange the appointment with the client?:

How would you like to receive your report?:

Would you like us to invoice you (the referring practice) directly? - Please note that if you would like us to acquire payment directly from the client we require payment in full on the day of scanning.:

 

 

Security Question: