Pet Owner Referral Form | Portland Vets

To refer your pet to our specialist team, please complete the form below. We will need to contact your current vet to obtain your pets medical history before we can proceed.

Important Information

By submitting this form, you confirm that you give permission for Portland Vets to contact your current vet to obtain your pets medical history. Your current vets contact email is required so we can request this information.

Referral Service Selection

Referral Service *

Preferred Branch *

Current Vet Permission

I give permission for Portland Vets to contact my current vet to obtain my pet's medical history *

Current Vet's Email Address *

Current Vet's Practice Name

Your Details

Title *

First Name *

Surname *

Email *

Home Telephone

Mobile Telephone *

Address Line 1 *

Address Line 2

Town/City *

County *

Postcode *

Pet Details

Pet Name *

Species *

Breed *

Colour *

Sex *

Neutered? *

Date of Birth *

Is the pet microchipped? *

Is the pet vaccinated? *

Is the pet insured? *

Insurance Company

Reason for Referral

Please describe why you are seeking a referral and any relevant history *

I have read, understood and agree to the practice terms and conditions

Once we have received your referral and obtained the medical history from your current vet, we will contact you to arrange a consultation appointment.

Your privacy is important to us - we will never share your details with anyone without your express consent.