Refer A Patient Online

Refer a Patient - Vets use Only

To refer a patient please complete the form below, attaching the patient clinical history and any relevant diagnostic imaging. Alternatively, our referral form can be downloaded and printed in PDF format - this can be found below;

Veterinary Referral Form - NEW DEC 18.pd

Owner Name

Patient Name:

Last Name

Owner Contact No

Reason for Referral

Referring Vet - Full Name

Practice Name

By submitting this referral, I give consent for the above noted patient to receive treatment for the condition described above at The Retreat Canine Hydrotherapy & Wellness Ltd which can include Hydrotherapy, Physiotherapy & Electro therapies as deemed suitable for the purpose of Rehabilitation.

I confirm I have included the patients clinical history and any relevant X-rays below.

Upload Clinical History

Max File Size 15MB