Veterinary Referral Form
Animal Details
| Name: | Age: |
| Breed: | Sex: |
| Description/Colour: | |
Owner Details
| Name: | Tel No: |
| Address: | Email: |
Veterinary Practice Details
| Practice Name: | Referring Surgeon: |
| Address: | Tel No: |
| Email: | |
Referral History:
I ………………………………………………. can confirm that I have received veterinary permission for Herts Horses and Hounds Hydrotherapy and Rehabilitation Centre Ltd to treat my animal using veterinary physiotherapy and/or equine hydrotherapy, under the Veterinary Surgeons Act 1966.
By ticking this box I give permission for photo’s and video footage of the horse to be used on our business social media and website. Please note diagnosis and histories will not be disclosed.
Signed …………………………………… Date……………