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Small Animal Referral Form - Helping you to help your clients

When you refer a client, we'll work with you to get an understanding of your client's case, based on medical history and previous test results.

After seeing your client, we'll report back to you with the results of examinations and treatments to help you provide ongoing care from your own veterinary practice, with ongoing advice from our specialists if required.

To make a referral to Small Animal Referral Services, simply submit the form below or download and fax the Small Animal Referral Form PDF.

By submitting the online form, a copy of the referral will be emailed to your email address supplied below.

* Compulsory fields

*
Clinic name and address: *
Client phone number: *
Fax:
Email address: *
I would prefer a written report by: *
Referral service required: *
Medicine Surgery  Pathology
Oncology Ophthalmology Acupuncture
Dermatology

 Pain clinic
Have radiographs been sent with patient: *
 Yes  No
Please return films: *
 Yes  No
Our client/practice will contact Murdoch University Veterinary Hospital directly to arrange an appointment date and time on 1300 652 494.
Our client/practice has already arranged the following referral appointment.
Date and time:
:
Owner's name: *
Address: *
Home phone: *
Work phone:
Mobile:
Email:
Animal's name: *
Animal's breed: *
Age: *
Sex: *
Species: Canine Feline Other *
Problem(s) for which the animal is being referred:
*
What is your provisional diagnosis:
*
Brief relevant history of the present problem(s) including treatment and response:
Results of diagnostic tests performed:

Attach below Results of diagnostic tests performed:

File format must be in PDF, JPG or GIF only with a maximum size of 1MB. This upload function is for laboratory results or imaging reports only. We ask that referring veterinarians do not upload patient records here unless they are short and succinct.
Details of medication the animal will be receiving at the time of referral:
Any other comments that you wish to make: