For veterinary practices

Veterinary referral form

Share the practice, client and patient details the team needs to prepare for a behaviour consultation.

Please complete the relevant details below. Fields marked with an asterisk are required.

PetBC - Veterinary referral

Veterinary Practice details

Referring practice name (address optional)

Contact Number

Practice email

example@example.com

Referring professional confirmation

I confirm that I am the referring veterinary professional and that the information supplied is accurate.

Print Name

Date signed

Client Name

First line of client address

Which contact details can you provide for the client?

Phone

Both email and phone

Client phone number

Client email

Animal's name

Species (breed if known)

Date of most recent health check

Most recent weight

Brief details of behaviour problem

Was the patient seen for the purposes of this referral?

Can you clinically examine the animal?

Do you give consent for a level 7 qualified and insured Veterinary Physiotherapist who we work alongside, to assess this animal too?

Did they require additional forms of restraint for the examination? (e.g. owner holding/nurse holding/muzzling etc.)

Please upload the patient’s medical history, including any test results (e.g. recent blood tests or radiographs).

Choose files

You can attach up to 10 files, up to 10 MB each. Choose PDFs, documents or images.

Sending the medical records later?

Records will follow

We’ll email your practice with an update once we’ve seen the patient. If you have any questions in the meantime, email the team.

Our accreditations

We use these details to prepare for the patient’s behaviour care. Privacy policy.