Surgical Services Referral Form

Dear colleagues,

Please fill out this form for all referrals for specialist surgical services. We will contact the client directly to schedule an appointment within 24 hours of receiving the completed referral form.

For urgent/critical cases or same day referrals, please contact us via our hotline 6931 0095 to speak with one of our friendly team members before transferring the patient.

Practitioner's Name:

Clinic's Name:

Clinic's E-mail:

Animal's Name:

Pet owner's name:

Pet Owner's E-mail:

Owner's primary contact number:

Owner's Secondary Contact Number:

Animal's Age:

Gender and Neuter Status:

Species:

Breed:

Presenting Complaint(s) :

Summary of Physical Exam and Findings:

Current Treatment (including medications and dosages):

Any Additional Comments/ Requirements:

Please upload any medical history, lab results and/or imaging files pertaining to the case below.

Please upload medical history, lab results and/or imaging files pertaining to the case

By submitting this form, I acknowledge that I have obtained the pet owner's consent to appropriately share their personal data with Westside Veterinary Emergency and Referral Hospital for the purpose of case referral.