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Practice*

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Telephone Number*

Mobile Number*

Pet Name*

Species

Sex

Neutered

Yes
No

Breed

Age

Colour

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Non-urgent Appointment (Next Available Appointment)
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Discipline(s) to which you are referring*

CT
Orthopaedic Surgery

Infectious

Yes
No

Brief summary of problem/reason for referral (Please always provide the full clinical history, lab results & any imaging relevant to the referral)*

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Refer a Case

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Practice Details

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