Referral form

If this is an emergency referral, please phone 08 8313 1999 to perform a vet-to-vet handover and inform the clinic of the patients case and arrival.

To submit a referral request to the Roseworthy Veterinary Hospital, please fill in the below form or email vet.reception@adelaide.edu.au and CC afterhoursvet@adelaide.edu.au.

Referring vet information

Referring clinic name

Referring veterinarian name

Referring clinic email address

Referring clinic phone number:

Urgent?

Is there a particular clinician you wish to refer to?

Client name

Client email

Client phone number

Patient name

Patient age or date of birth

Patient species and breed

Patient sex & desexing status

Patient vaccination status

Weight (kg)

Suspected infectious disease?

If the patient is a horse, have they travelled to NSW or QLD in the past 30 days?

Patient case notes / summary

Does the patient have any behavioural concerns?

Any known allergies or alerts we should be aware of?

Please attach the patient's history (Medical notes, imaging and laboratory notes)

Attach