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Advice Request Form
1. Referring Practice Details
2. Patient Details
1. Referring Practice Details
Type of advice
*
Routine
Urgent (within 2 days)
Emergency (same day)
Note: For emergencies you must ALSO call the hospital as well as completing this form.
Referring Practice Details:
Referring Vet's Name
*
Practice Name
*
Address
*
Email
Telephone number
*
Veterinary Surgeon Qualifications
Have you already discussed this patient with one of our colleagues?
*
Yes
No
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