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Referral Form

Submit an equine referral case here

Welcome to Pool House Equine Hospital - Referral Services Referrals can be made by completing the referrals form or with our Hospital Office by calling 01283 799700 during office hours (Monday-Friday 8.30 am-5.30pm)

Urgency of Referral:

Urgent - Emergency
Fairly Urgent
Non-Urgent

Select the discipline required*:

Orthopaedics
Internal Medicine
Soft Tissue
Dentistry
MRI
Dermatology
Opthalmology
Cardio-respiratory
Other

Condition being referred for:

Is client aware of likely referral costs?:

Yes
No

Owner Details

Title:

Name:

Address Line 1:

Address Line 2:

City:

Postcode:

Email:

Telephone (Main):

Telephone (secondary):

Referring Vet Details

Title:

Name:

Practice Name:

Practice Address Line 1:

Practice Address line 2:

Practice City:

Practice Postcode:

Practice Telephone:

Practice Email:

Animal Details

Name:

Sex of patient:

Male
Female

Age:

Breed:

Is horse insured?:

Yes
No

Insurance Company:

Insurance policy number:

Has a claim started on this condition?:

Yes
No

Clinical History

Description of Clinical History:

How did you hear about us?:

Recommended
Previous referral
Website
Facebook
Other

Attachments

Upload File 1:

Upload File 2:

Upload File 3:

Upload File 4:

Security Question:

I have read and agreed to the privacy notice:

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Company's registered name: Independent Vetcare Ltd

Registered number: 07746795

Registered Address: The Chocolate Factory, Keynsham, Bristol BS31 2AU

Authorised and regulated by the Financial Conduct Authority for credit-related regulated activities under reference number: FRN738010

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About
Careers
Mobile Services
Hospital
MRI
Referrals
CPD & Events
- Conference Room
Pay Online
Contact Us

Refer a Case

Pool House Vets Small Animal
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