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

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: