Vet Referral Form | The Referral Centre

Client Details
Name*
First Last
Address*
Street Address Address Line 2 City Region ZIP / Postal Code
Mailing Address (if different above)
Street Address Address Line 2 City Region ZIP / Postal Code
Which service do you require?*
- Medical or Critical Care Referral (Hamilton)
- Skin Referral (Hamilton)
- Eye Referral (Hamilton)
- Surgery Referral (Hamilton)
- Ultrasound only Referral (Hamilton)
- Exotic Pet Referral (Tauranga)
- Advanced Imaging (CT MRI) (Hamilton)
- Dentistry (Hamilton)
- Rehabilitation and Hydrotherapy (Hamilton)
Email Address*
Contact Number 1*
Contact Number 2

Referral Details
Veterinarian Referred To
Reason For Referral
Brief Summary of Current Clinical Condition
Current Medications
Clinical Notes
Drop files here or

Max. file size: 100 MB.
We need referring clinics to ensure a full and complete history (including lab work, relevant diagnostic imaging etc) accompanies each referral. In the event the file is too big to attach to the referral form, this information can be emailed separately to waikato@thereferralcentre.co.nz
Clinical Notes Attached?*
- Yes
- No
Images Provided
Drop files here or

Accepted file types: (iejpg, gif, png, pdf), Max. file size: 200 MB.
We need referring clinics to ensure a full and complete history (including lab work, relevant diagnostic imaging etc) accompanies each referral. In the event the file is too big to attach to the referral form, this information can be emailed separately to waikato@thereferralcentre.co.nz
Images Attached?*
- Yes
- No
Diagnostic Results
Drop files here or

Max. file size: 200 MB.
We need referring clinics to ensure a full and complete history (including lab work, relevant diagnostic imaging etc) accompanies each referral. In the event the file is too big to attach to the referral form, this information can be emailed separately to waikato@thereferralcentre.co.nz
Diagnostic Results
Drop files here or

Max. file size: 200 MB.
We need referring clinics to ensure a full and complete history (including lab work, relevant diagnostic imaging etc) accompanies each referral. In the event the file is too big to attach to the referral form, this information can be emailed separately to waikato@thereferralcentre.co.nz
Diagnostic Results Attached?*
- Yes
- No

Referral Form

Referral Form

Step 1 of 4 - Client Details

Client Details

Animal Details

Referring Clinic Details

Referral Details