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Referred Case Registration Form
Registration Form for Routine Appointments
NB: This form should ONLY be used by Veterinary Professionals not by clients wishing to make an appointment. If you are a pet owner, either contact your vet for referral or telephone Willows on 0121 712 7070 for assistance.
The following form should be completed and accompanied by a referral letter, full clinical history, including laboratory results and radiographs (please supply normal and abnormal results). The history, test results/radiographs and a covering letter can either be uploaded using this registration form (see below) or they can be emailed separately to: firstname.lastname@example.org (if emailing, please include the Referred Case Registration Number which will be emailed to you once this form has been submitted).
To arrange an appointment
After you have submitted the form, our reception staff will contact either you or your client directly to arrange an appointment (depending on your contact preference indicated below). For emergency, urgent and out-of-hours cases, please see the following instructions.
Emergency, Urgent and Out-of-Hours Referrals
For emergency, urgent and out-of-hours referrals, please DO NOT use this form, but instead call reception
on 0121 712 7070 to speak to a member of staff.
All information submitted will be held securely and used only by Willows Referral Service, and never passed to third parties without your express permission.
Please complete the following details:
(NB: This form should ONLY be used by Veterinary Professionals, not by pet owners)
* Denotes a required field