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Refer a Case Form

Complete the form below to refer a case

If your case is an emergency, please do not refer online. Please phone our team on 01453 547934.

For all non-urgent referrals we aim to contact your client within 1 working day to start the referral process.

Practice Details

Client Details

Patient Details

Patient Species:
Was this animal or their parents imported?:
Has this animal ever travelled outside the UK?:
For dogs that have been imported from or travelled outside of the UK, has serology for Brucella Canis infection been performed?:

For non-urgent cases, we may ask you to perform Brucella canis serology at the APHA (SAT +/- RSA testing) prior to referral. 
PCR, ELISA and SNAP test results will not be considered proof of negative status. A copy of the APHA laboratory report will need to be sent to us prior to the appointment.    

 

For urgent or emergency cases, we may perform an in-house SNAP test at the time of the appointment at Vale Referrals, as well as submitting a sample to the APHA. 
The dog may need to be barrier nursed in our isolation facilities pending the result of the test and some of the diagnostic investigations may need to be postponed until the results are known. 

 

Is the animal insured?:
Direct Claim Requested?:

Referral Details

Service Required:
Urgency of the case:
Would you like an estimate?:

Attachments

Please attach the appropriate case history and any additional records e.g. test results, radiographs, ECG tracings etc (Max total file size 30MB per file).
Security Question:

It is the responsibility of the referring practice to send up to date history and relevant lab work prior to the patient being seen.