Scheduled Website Maintenance

Willows Veterinary Centre & Referral Service website will be temporarily unavailable for system maintenance on Saturday 25 March 2017 from 9pm until midnight GMT. We apologise for any inconvenience and thank you for your patience.

Veterinary Professionals Login



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Veterinary Professionals Sign Up

  • Quick and easy referral registration
  • Optional CPD notification
  • View your history of referrals to Willows
  • Entry into prize draw*
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*See terms and conditions

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To register a case as a guest without
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Referred Case
Registration Form
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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: [email protected] (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

FORM CONTAINS ERRORS!  Please review, correct and resubmit.

If you need to contact us please call +44 (0)121 712 7070.

Referring Veterinary
Surgeon's Details (About You)

Please complete your first name

Please complete your last name

Please complete the Practice Name

Please complete the Practice address details

Please complete the town

Please complete the country

Please complete the practice postcode

Please complete your contact telephone number

Please insert a valid email address

Email address already taken

Your email address does not match

Owner's Details

Please complete the owner's name

Please complete the owner's Last Name

Please complete the owner's address details

Please complete the owner's town

Please complete the owner's postcode

Please complete the owner's telephone number

NB: Please ensure that telephone numbers are current and accurate and include an STD code




 

Patient's Details

Please complete the patient's name

 

Details of Referral

Please select the discipline to which you are referring

Please indicate your contact preference

Please describe the condition and the reason for referring

 
Clinical history and previously performed diagnostics (please include normal as well as abnormal results)

Please email a copy of the clinical history and images to Willows at your earliest convenience.

Please also include any covering letter or other information that you feel may be useful.

Information should be sent to [email protected], remembering to quote the case referral reference number in all correspondence (the referral reference number will be emailed to you automatically once this form is submitted).

Please upload a copy of the clinical history including blood tests, urinalysis, cytology or histopathology results and radiographs using the upload button below. A brief referral letter outlining the nature of the referral is much appreciated and can help increase the efficiency of case throughput and follow-up reporting.

For each file please click on the 'Add File(s)' button.

Please keep in mind that the maximum combined size for all files is 10MB. Further information can be emailed to [email protected] remembering to
quote the case referral reference number in
all correspondence (the referral reference number will be emailed to you automatically once this form is submitted).

Clinical History

Drag attachments or

Browse and Add File

Note: We accept files in the following formats: .pdf, .doc, .docx, .xls, .xlsx, .rtf, .txt, .jpg, .bmp, .gif, .tiff, .png

Attachment Checklist

  • Referral letter
  • Clinical history
  • Blood results
  • Urinalysis
  • Cytology/Histopathology
  • Radiographs

Clinical history and previously performed diagnostics may be faxed to 0121 712 7077. Please tick the box if you intend to fax over

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  • Must be different from your Username
  • Must contain at least 8 characters including one capital letter and number
  • May include the following characters:
    % & _ ? # = -

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Please type a password with at least 8 characters, 1 uppercase letter and 1 number

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Prize Draw

For each case submitted via the online referral form in any quarter, your name will be entered into a quarterly prize draw, provided that the case is seen as an appointment (referrals which fail to come to an appointment will not be included in the prize draw).

To opt-out please tick this box.

Processing your registration details

Attachment review
prior to submiting:

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