Refer a Case

Referring Veterinary Surgeon's Information
Vet's Name
First Last
Vet Clinic and Branch
Clinic Telephone Number
Email
Date
Date Format: DD slash MM slash YYYY
Patient/Pet Information
Animal's Name
Pet's Name Owner's Surname
Species
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)
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).
Please list current medications:
Any other relevant information:
Is this case an emergency, urgent or routine request?
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 admin@vvs.vet.
X-Rays / Imaging
X-Ray / Imaging
Drop files here or
Lab Results
Lab Results
Drop files here or
Patient Records
NB: Not for Advice Calls - History Summary Only Please
Patient Records
Drop files here or
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

‘Virtual Veterinary Specialists wish to fully support vets in adhering to COVID-19 social distancing rules whilst also providing excellent patient care. We trust veterinary teams to have put appropriate measures in place to protect themselves and their clients but are happy to help if you require support to safely conduct consultations and procedures under the current restrictions. We will work with you to care for your patients, whilst also protecting you and your team.
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Refer a Case

Referring Veterinary Surgeon's Information

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