Vet Referral Form

If you are a veterinary surgeon and would like to refer an pet to us, please complete the below form. If you have any questions please email us or give us a call on 0121 270 5800:

Owner's Details

Name

First Name

Last Name

Phone

(###)

###

####

Pet Details

Pet Name

Pet Date of Birth

Species

Breed

Sex

Male

Female

Colour

Consents

I give my consent for the above described animal to undergo the following at Horner Pet Rehab & Wellness Centre:

A physiotherapy assessment

Physiotherapy and/or Hydrotherapy treatment

Receive non-invasive photobiomodulation treatment

If you did not consent to all of the above assessments and treatments please explain why:

Veterinary Surgeon Information

Name of Referring Veterinary Surgeon

Practice Name

Practice Address

Vet Email

Vet Phone

Pet's Condition

What is the primary condition being referred for treatment?

Are there any other significant conditions that may affect the patient's treatment?

What medication is the patient on?

Are there any behavioural concerns we should be made aware of?