Refer a Case

Please use the below form to refer a case.

We are currently not accepting any new Dermatology referrals due to a long waiting list. We will update you once we re-open the discipline again.

Please note, we are unable to process any applications without the relevant documents which need to be attached at the bottom of the form. Please make sure that the attachments are under 20MB.

Referring vet's email

Referral Discipline*

Urgency*

Brief summary of case history*

Referring Vet*

Qualifications

Practice Name*

Practice Telephone Number*

Client Name (with Title)*

Client Email

Client Mobile Number*

Client Full Address

Pet's Name*

Species (eg cat, dog, rabbit)*

Breed of pet*

Age of pet

Sex of pet*

Insured?*

Has a previous insurance claim been submitted? How was the claim worded?

Insurance Company :

Is client aware of likely referral costs?

How much has been estimated?

Full Medical History

Max. file size: 50 MB.

Images or Results

Drop files here or

Max. file size: 50 MB.