Cardiology Referral

You can arrange a referral by completing the form below:

Alternatively, you can send an email to: small.animal@oakhamvethospital.co.uk

Patient histories will need to be sent via email to us prior to the patient’s initial consultation.

We aim to see cases as promptly as possible, with emergency cases taking priority.
If you would like to discuss a case with Chris prior to referral please phone our reception team on 01572 722646.

For more information about our referrals service please do not hesitate to contact us.

Services provided:

Arrhythmias
Episodic Weakness
Collapse
Congestive Heart Failure
Holter Monitoring
Pericardial Disease

Referring veterinary surgeon:

Surgeon Name*:

Practice Name*:

Practice City*:

Practice Postcode*:

Practice Phone*:

Practice Email*:

Owner Details

Please leave non-mandatory fields if they are in the patient history.

Owner Title:

Owner First Name*:

Owner Surname*:

Owner Address Line 1*:

Owner Address Line 2:

Owner Address Line 3:

Owner City:

Owner County:

Owner Postcode:

Owner Home Phone*:

Owner Mobile Phone*:

Owner Email*:

Patient Details

Please leave non-mandatory fields if they are in the patient history.

Patient's Name*:

Species:

Sex:

Neutered:

Yes
No

Breed:

Age:

Colour:

Insured?:

Clinical History Upload

Please attach full historybelow or email to small.animal@oakhamvethospital.co.uk prior to the patients appointment

Attach History:

Attach a File:

Additional comments:

Security Question:

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Cardiology Referral