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Laparoscopic Referral

This form is only for use by veterinary surgeons to arrange routine laparoscopic neutering for a healthy bitch. For other endosurgery referrals, including laparoscopic gastropexy, please use our regular referral form. Referral forms for other disciplines, and downloadable PDF versions of referral forms, can be found here.

If you have a pet who you wish to be seen at South Devon Referrals, please contact your veterinary practice and ask them to contact us to arrange referral. We will then contact you to arrange a convenient appointment time.

You will receive a copy of the online request form by email: if you do not receive this then please contact us by other means to confirm we have received your request (please check your spam folder).

All items marked with an asterisk (*) are required. Please check they are completed and once you have submitted the form ensure you receive the message “Your message was sent successfully, and we have sent you a copy. Thank you.” which will appear under the submit button.

Laparoscopic Neutering Request for Healthy Bitch

Practice Details

Client information

Patient information

Has this animal been imported or travelled abroad?:
If yes, has this animal had a negative Brucella antibody test at least 3 months after return to the UK?:
Please note, we will not accept referrals for travelled animals without evidence of a negative Brucella test. Positive animals will unfortunately not be accepted for referral.

History

More detailed information can be uploaded in the Attachments section.
Tick if the patient has:
Please attach the appropriate case history and any additional records e.g. test results, radiographs, ECG tracings etc (Max total file size 8MB).

Insurance

Is the animal insured?:

It is the responsibility of the referring practice to send up to date history and relevant lab work prior to the patient being seen.

 

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