Veterinary Referral

A Veterinary referral needs to be completed and signed before an inital assessment can be completed. This is to ensure that the health of the dog has been considered fit enough for hydrotherapy treatment to go ahead by your veterinarian.

Woods Hydrotherapy Veterinary Referral form

Please use the button below to access a downloadable copy of the veterinary referral form.

Veterinary referral form

Owner Details Name: ____________________________________________________________

Address: ________________________________________________________________________

Home Telephone no: _______________________Mobile No: __________________________

Email Address: __________________________________________________________________

Dogs Details Name:________________________ D.O.B: ________________ Breed:_____________________ Sex: M / F

Vet Details (To be completed by your veterinarian)

Practice Name and Address:_____________________________________________________ _________________________________________________________________________________

Contact Number:________________________________ Email__________________________

Address:________________________________________________________________________

Name of referring veterinary surgeon:____________________________________________

Reason for referral/relevant history to be included: _______________________________ _________________________________________________________________________________

Current Medication:_____________________________________________________________

Veterinary Declaration to be signed by referring veterinary surgeon: By signing this referral form I agree that the stated dog is in a suitable state of health to undergo hydrotherapy treatment.

Signed: Date: