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LUMBRY PARK
REFERRAL REQUEST

Referring Vet

Email

Practice Name

Phone Number

Owner's Details

Owner's Name

Owner's Email

Owner's Phone Number

Owner's Mobile Number

Owner's Address

Patient's Details

Patient's Name

Species

Breed

Gender

Date of Birth

Weight (KG)

Neutered?

Brief Clinical History (Including current treatment)

Which discipline would you like to refer this patient to?

Reason for referral?

Specific questions to be answered?

Please upload any relevant files (full history, Xrays, Lab results, etc) preferably in PDF format

If you are having any difficulties uploading the files please tick the relevant box of what is missing. Please email them to enquiries@lumbrypark.co.uk ASAP

Is this Pet insured?

Please provide us with the patient's insurance company

Refer a patient

If you are a veterinary professional and want to refer a case please click the button below:

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