Refer a Client - Rutland House Referrals

If you need to refer a client urgently, please fill this form AND contact us on 01744 853 510.

Referring Veterinary Surgeon's Details:

Name *

Practice *

Practice Address *

Practice Postcode *

Telephone Number *

Fax Number:

Email *

Client Details:

Client's Name *

Patient's Name *

Client's Address *

Town *

Postcode *

Telephone *

Client's E-mail Address *

Patient Details

Name *

Species *

Age *

Colour *

Sex *

D.O.B *

Breed *

Neutered? *

Which department do you require?

Department *

What is the specific problem/investigation/treatment for which you wish to refer the patient ? *

History / X-rays will be sent via *

History / X-rays File Upload *

History / X-rays File Upload

Please contact me prior to the appointment to discuss the case. *

Do you want a receptionist at Rutland House Refferals to contact the client and make an appointment ? *

For further information, please call: 01744 853510

Keeping in touch

by email

by phone (including text message)

by post

Yes please, I would like to receive reminders (i.e. appointments, boosters and treatment reminders)

by email

by phone (including text message)

by post

Yes please, I would like to receive marketing communications (i.e. products and services)

Terms & Privacy *

I agree and I am over the age of 18

I agree to have read and accepted your terms and privacy policy. Your privacy is important to us and you can find out more about how we use your data from our “Full Privacy Notice” which is available from in the links above.

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