CT referrals

CT form page:

We have an in-house CT scanner at our main site in Quedgeley, allowing us to capture highly detailed, 3D diagnostic images.

If you would like request a CT referral, please complete the form below.

Referring vet's email

Urgency*

Brief summary of case history*

Referring Vet*

Qualifications

Practice Name*

Practice Telephone Number*

Client Name (with Title)*

Client Email

Client Mobile Number*

Client Full Address

Do you consent for us to contact that practice for a copy of the pet's medical history?*

Agree terms and conditions

Pet's Name*

Species (eg cat, dog, rabbit)*

Breed of pet*

Age of pet

Sex of pet*

Insured?*

Has a previous insurance claim been submitted? How was the claim worded?

Insurance Company :

Is client aware of likely referral costs?

How much has been estimated?

Full Medical History

Max. file size: 50 MB.

Images or Results

Drop files here or

Max. file size: 50 MB.

Untitled

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Second Choice

Third Choice