Veterinary referral

Name *

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Veterinary surgery *

Thank you for this referral.

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Patient diagnosis *

Patient Name *

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Last

Patient address *

Client email address

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Client telephone number *

Medication currently prescribed *

Comment, Message or additional concerns *

Veterinary Consent *

I have examined the above dog named animal at rest. I can see no reason why he/she should not be assessed by a qualified Veterinary Physiotherapist and potentially undertake moderate controlled exercise, therapies and/or be subject to careful manipulation (Physio only). I have not been able to evaluate his/her “cardiovascular” capacity for swimming but see no reason why this shouldn’t be performed given the state of the animal.