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Castle Vets Referral Form

For Vets Only

Please complete the Referral Form and submit it, along with your patient’s clinical history.  Once we have this information, we are happy to contact your client directly to arrange an appointment.

For urgent appointments, please feel free to telephone the practice on 0118 957 4488 to discuss your patient’s needs.

Please inform your clients that we require payment in full on the day of the scan/procedure, unless a pre authorisation is in place for a direct claim.

If your clients are insured and wish to do a direct insurance claim, we require that a pre authorisation claim is completed prior to their appointment. We are happy to arrange this directly with your client and will discuss this with them when we contact them. If  your client has already made a successful insurance claim for this condition please let us know as this may mean we can agree a direct claim without a pre authorisation.

Practice Details

Owner and Patient Details

Referral Details

Type of Referral*:

Discipline(s) to which you are referring*:




Attachments

Please attach the appropriate case history and any additional records e.g. test results, radiographs etc (Max total file size 8MB).
Would you like this to be an outpatient referral? i.e. do you want us to do the CT scan or ultrasound and send the results back for you to report and treat?:

Would you like us to call you to discuss your patient?:

Security Question: