Referral Form - Portland Vets

To learn more about the referral disciplines we cover, the services we offer and the facilities we have available please read our Referral Services page.

If you have a case you wish to refer, please complete the form below. Alternatively, contact us to discuss your case.

⚠️ Urgent surgical or medical referrals

If you have an urgent referral, please call 01342 327799 prior to submitting the form.

📧 After completing the form

Once you have completed and submitted the form below, please email the full history, including all relevant lab results and/or X-Rays to [email protected]

Vet Referral Form

Fields marked with an * are required

Referral Service Selection

Referral Service *

Preferred Branch *

Referring Vet Details

Title *

Forename *

Surname *

Email *

Practice Telephone *

Practice Name *

Address Line 1 *

Address Line 2

Town/City *

County *

Postcode *

Client Details

Title *

Forename *

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

Referral Details

Would you like us to contact the client to book the appointment? *

Reason for referral and brief history *

Contact preferences if results require reporting? *

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

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