This form should ONLY be used by veterinary surgeons and not by pet owners. If you are a pet owner and would like your vet to make a referral to us for this service, please complete this form.

A member of our client care team will contact your client directly to book an appointment.
Please DO NOT use this form in an emergency/urgent referral, please contact us by phone on 01262 677269

If you are having problems submitting the form, please email rehab@aldgatevet.co.uk or call us on 01262 677269.

Referral details *

Owner's details
Pet's details
Sex *
Neuter status *
Referring practice details
Please note that there are some conditions which limit our ability to treat the patient, either for safety or hygiene reasons. Please inform us if the patient suffers from any of the following, secondary to the condition for which they have been referred. We may request further information from you to determine what the best treatment options are: *
Veterinary consent

I certify that the above-named pet is under my care. In my opinion, this pet is in a suitable state of health to undergo the proposed rehabilitation treatment.

Veterinary surgeon signature:

Clinical history upload

Please upload patient clinical history, laboratory results and any imaging relevant to the referral.

Many thanks for your referral. A treatment report will be emailed to the case clinician following initial examination. Subsequent communication will occur following treatment cessation or if there are changes to clinical presentation during treatment.