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Refer a Case

Information for Pet Owners

Refer a New Case

Refer a New Case

This form collects case data and sends it to Provet

"*" indicates required fields

1Your details

2Patient details

3Referral details

4Clinical details

Veterinary Practice*

Practice Post Code*

Veterinary Surgeon*

Email*

By submitting your email you agree to join our communications list. You can opt out at any time by emailing ‘unsubscribe’ to info@ratavetsurgery.co.uk or clicking the unsubscribe button on the correspondence

Phone number*

Patient name*

Owner Surname*

Sex*

Female

Male

Neutered*

Yes

No

Species*

Canine

Feline

Date of birth*

YYYY dash MM dash DD

Breed*

Weight (kg)*

Please enter a number greater than or equal to 0.

BCS (1-9)

Please enter a number from 1 to 9.

Has the dog travelled to, or originated from, a 'high risk' Brucella country?*

Yes

No

(Click HERE for a list of 'high risk' countries.)

Has the dog been blood tested for Brucella with a clear result?*

Yes

No

Referral Type*

Orthopaedic - request surgery

Orthopaedic - request consultation/assessment

Orthopaedic - request second opinion

Soft tissue - request surgery

Soft tissue - request second opinion

Opthalmology - request surgery

Opthalmology - request consultation/assessment

Opthalmology - request second opinion

Imaging. Ultrasound - Abdominal*

Imaging. Ultrasound - Cardiac*

Imaging. Free second opinion on existing images (not ortho or surgery related)*

Ophthalmology available within 90 minutes drive of Bristol.
* Service only available in the South West

Please attach a full clinical history (PDF) and photographs of the eye where possible.

Limb affected:*

Left Hind

Right Hind

Left Fore

Right Fore

N/A

Is this case*

Urgent (e.g. fracture, acute eye disease)

Non-urgent

If requesting a surgical booking, will you require a Rata RVN to provide anaesthetic support for the case?

Yes

No

Presenting problem & clinical signs*

Files

Drop files here or

Max. file size: 146 MB.

Pertinent medical conditions

Findings under anaesthetic e.g cranial draw, Ortolani test positive

Current treatment/previous surgical intervention

Suspected diagnosis

Date condition started

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Orthopaedic

Orthopaedic Consultations and Assessments
Radiographic Reporting
Cruciate Disease
Patella Luxation
Fracture Management
Hip Luxation
Elbow Dysplasia Management
Humeral Intracondylar Fissure (HIF)
Stem Cell Therapy
Arthrodesis
Angular Limb Deformity
Management of OCD
Canine Osteosarcoma

Soft Tissue

Neck surgery (Salivary mucocoele, thyroidectomy)
Aural (TECA-BO, VBO)
Mast Cell Tumours (MCT)
Airway (BOAS and Laryngeal Paralysis)
Abdominal Surgery (PSS, biliary mucocele, liver biopsy)
Perineal surgery (Anal gland sacculectomy, hernia etc)
Surgical management for neoplasia

Ophthalmology

Tumour Excision
Ophthalmology Consultation
Distichiasis, Trichiasis and Ectopic Cilium
Entropion
Ectropion
Prolapsed Nictitans Gland (Cherry Eye)
Corneal Ulceration
Glaucoma
Corneal Sequestrum

Ultrasonography

Thoracic Ultrasound
Head and Neck scanning
Ultrasound - Guided Sampling
Musculoskeletal Procedures
Abdominal Ultrasonography
Echocardiography

A–Z of Procedures