Refer a Case

Referring Veterinary Surgeon's Information
Vet's Name*
First Last
Vet Clinic and Branch*
Vet Clinic and Branch Patient is Registered (if different from above).
Clinic Telephone Number
Email
Date
DD slash MM slash YYYY
Have you already confirmed an appointment for this patient with the VVS team?
- Yes, I have booked an appointment.
- No, please contact me with availability.
For New Practices
For practices using the VVS service for the first time, please provide the following information.
Email Address for Invoice
Contact Name for Invoice
Patient/Pet Information
Animal's Name*
Pet’s Name Owner’s Surname
Species*
If other, please specify species
Breed*
Weight in Kgs*
Sex/Neutered*
Age*
Nature of Problem/Reason for VVS Consultation
Which Specialist discipline do you require?*
Notes
Which type of VVS service do you require? E.g. Specialist advice call, Live-guided consultation, Specialist written case report. Please enter the code for the VVS service you require (if known).
For all VVS Radiology Report requests and VVS Holter requests please do not proceed with this form. Please complete the specific VVS forms for these services which can be found by visiting the ‘Contact us’ tab of our website.
Notes
Please describe the pet's condition and provide a brief summary of the relevant history (NB: This history summary needs to be provided in addition to attaching the patient records).*
What date is the patient history relevant from, or when did the patient first present with this condition?
Please list current medications:
Any other relevant information:
For Live-Guided Procedures only: Are you able to place an IV catheter without prior sedation in this patient? Is the patient nervous and/or aggressive in the veterinary practice?
Sedation support will be offered if required.
Is this case an Emergency, Urgent or Routine request?
For Emergency cases please call 0207 043 2283 to speak with a member of the team. The suggested time intervals are a guide. Subject to availability and normal service hours.
Patient Records and Relevant Diagnostic Test Results
Please upload a copy of the patient records including blood tests, urinalysis, cytology or histopathology results and radiographs. Select Yes or No to indicate what has been submitted in addition to this form. You can also email these to [email protected]. X-ray/Imaging submission is limited to 8 files. Maximum file size is 500MB. Larger files please email separately to [email protected]. FOR ALL RADIOLOGY REPORTS please submit DICOM files for radiology review. DICOM files will need to be sent via your PACS system, WeTransfer, Dropbox or Google drive to [email protected].
X-Rays / Imaging
FOR ALL RADIOLOGY REPORTS please complete the separate VVS Radiology Request form which can be found using the following link- www.vvs.vet/vvs-radiology-service/. DICOM files will need to be sent separately via your PACS system. Alternatively we can send an upload link for you to submit your DICOM files to, please contact [email protected] to arrange this. Please submit a maximum of 5 files. To submit additional files please contact us directly. Maximum file size is 500MB. Larger files please email separately to [email protected].
X-Ray/Imaging
Drop files here or

Max. file size: 50 MB, Max. files: 8.
Lab Results
Lab Results
Drop files here or

Max. file size: 50 MB.
Patient Records
Please submit relevant case history or a written case summary for advice calls.
Patient Records
Drop files here or

Max. file size: 50 MB.
Previous Relevant Referral Reports (Non VVS)*
Please submit any previous relevant referral reports or letters. You do not need to submit any previous VVS reports.
Previous Relevant Referral Reports (Non VVS)
Drop files here or

Max. file size: 50 MB.
Please submit any previous relevant referral reports or letters. You do not need to submit any previous VVS reports.
Getting the Most out of Your VVS Consult
Please tell us what question(s) you would like to answer about this case:*
Please also tell us what you are hoping to achieve from this consult:
Consent

All of the patient information provided is complete to the best of my knowledge and I accept VVS are only able to provide services based on the information provided to them. The primary case responsibility remains with the referring clinician.
Save Surgery Information
- I would like to save my surgery information for next time I fill out this form.
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Refer a Case

Referring Veterinary Surgeon's Information

For New Practices

Patient/Pet Information

Nature of Problem/Reason for VVS Consultation

Patient Records and Relevant Diagnostic Test Results

Getting the Most out of Your VVS Consult