To refer a client to us for behaviour support, please complete the form below. You’ll have the option to attach the relevant vet history here or to send it over to us separately.

Once you’ve submitted the form we’ll be in touch as soon as we’ve spoken to the client.

Any questions please email us at hello@caninethinking.com

Vet Referral Form

Referring Vet

Referring vet name:(Required)

First Last

Practice:(Required)

Practice Address:(Required)

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Practice Phone Number:(Required)

Practice Email:(Required)

Optional:

Your direct phone number:

Your direct email:

Client

Client Name:(Required)

First Last

Client Address:(Required)

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Client Phone 1:(Required)

Client Phone 2:

Client Email:(Required)

Client notes:

If you wish to add any further information about the client, please do so here

Dog(s)

How many dogs in the home of the above client are being referred for behaviour support?(Required)

Please enter a number greater than or equal to 1.

Dog 1

Dog Name:(Required)

Dog Date of Birth(Required)

Breed:(Required)

Gender:(Required)

Male

Female

Weight:

BCS:

Neuter status:(Required)

Reason for referral:(Required)

Date of last check-up:(Required)

Dog 2

Dog Name(Required)

Dog Date of Birth(Required)

Breed:(Required)

Gender:(Required)

Male

Female

Weight:

BCS:

Neuter status:(Required)

Reason for referral:(Required)

Date of last check-up:(Required)

Dog 3

Dog Name:(Required)

Dog Date of Birth:(Required)

Breed:(Required)

Gender:(Required)

Male

Female

Weight:

BCS:

Neuter status:(Required)

Reason for referral:(Required)

Date of last check-up:(Required)

Dog 4 or more

Please include details of other dogs here:

Clinical history

Please ensure this includes results of any diagnostics including bloodwork, urinalysis, faecal screens, allergy panels, imaging etc. You are welcome to upload files here or email direct to clients@caninethinking.com, whichever is easiest for you.

Will you send history via email or attach to this form?(Required)

I will email the vet history to clients@caninethinking.com

I will attach the history to this form

File(Required)

Max. file size: 50 MB.

If the patient is being seen by any other veterinary or rehabilitation professionals that you are aware of, please provide brief details here:

E.g. referral specialist, acupuncture, herbal vet, physiotherapy, hydrotherapy, nutritionist

Patient notes:

If you wish to add any further information about the patient, please do so here. For example, please highlight any specific medical information that you feel is relevant to the presenting concerns.

Vet Referral Form

Referring Vet

Client

Dog(s)

Dog 1

Dog 2

Dog 3

Dog 4 or more

Clinical history

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