Refer a Case

Please note this form is for Referring Veterinary Surgeons only. If you would like to refer your horse to Thistle Equine Referrals, please contact your veterinary surgeon.

Thistle Equine Referrals do not currently accept emergency referrals.

Referring Vet Details

Referring Vet*:

Practice Name*:

Practice Telephone*:

Practice Email*:

Owner Details

Title*:

Client Name*:

Address Line 1*:

Address Line 2:

City*:

Postcode*:

Telephone Number*:

Client Email Address*:

Horse Details

Horse Name*:

Age*:

Horse Colour (optional):

Horse Sex*:

Breed:

Horse Use*:

Horse height approx. (optional):

Is horse insured?*:

Yes
No

If yes - company insured with :

Any further comments regarding insurance:

Clinical History

History and Presenting Signs*:

Clinical examination findings*:

Diagnostics to date and findings*:

Recent medication:

Attachments

Upload File 1:

Upload File 2:

Upload File 3:

Upload File 4:

Security Question:

I have read and agreed to the privacy notice:

Refer a Case

Please note this form is for Referring Veterinary Surgeons only. If you would like to refer your horse to Thistle Equine Referrals, please contact your veterinary surgeon.

Thistle Equine Referrals do not currently accept emergency referrals.

Referring Vet Details

Owner Details

Horse Details

Clinical History

Attachments

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