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Refer Now

Home
Services
For Vets
For Owners
- Information
- Paying for Treatment
Contact
Referral Form

Referral Form

I'm a vet I'm a pet owner

Refer to EKVR

Please complete our online referral form for any non-urgent referrals or advice requests.

If you have an emergency please call us on 01304 272 131.

Please rest assured that no referral clients will be taken on for first opinion services at Beacon View.

Referral Form

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This field is for validation purposes and should be left unchanged.

Service Required(Required)

Referring Vets Details

Referring Vets Name(Required)

Referring Vet Practice(Required)

Referring Vet Contact Number(Required)

Referring Vet Email(Required)

Owner Details

Owners Name(Required)

Owners Email

Owners Phone(Required)

Patient Details

Patient Name(Required)

Species(Required)

Insured?(Required)

Insurance Company

Policy Number

Is the client hoping to do a direct claim?

Information and history

Body area(s) to be scanned (please tick all that apply)(Required)

Thorax

Abdomen

Carpi

Elbows

Shoulders

Stifles

Tarsi

Head

Cervical spine

Thoraco-lumbar spine

Pelvis

Other (please specify)

Other area to be scanned

Report turnaround time

Do you want an intravenous contrast study to be performed using Iohexol?

Has the patient had a blood test including kidney parameters performed in the last 2 weeks?

Clinical questions to be answered by the radiologist

If further investigations are warranted during the CT procedure would you like us to contact you before we proceed?

Brief Outline of Case

File upload

Drop files here or

Max. file size: 10 MB.

Please attached history, radiographs, lab reports and any other relevant information. For large files please use wetransfer and send to [email protected]

Unsure whether a case needs referral?

Submit a clinical advice request and one of our team will be happy to discuss options with you.

EKVR
High Street
Eastry
Sandwich
CT13 0HE

[email protected]

01304 272 131

Links

Refer online Careers EMS placements Beacon View

01304 272 131 Email us

Chat to one of the team