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Veterinary Referral Form



Vet practice details

Reason for referral

Reason for Referral

if 'post diagnosis' please fill in 'diagnosis' section further down



Risk other limbs becoming affected?
Onset of condition
Surgery performed

Any additional info

If you have any supporting documents that will help with physiotherapy treatment, please upload them below.

Upload File


By submitting this form you are declaring that this animal is a patient under your care and you consent to them receiving a physiotherapy assessment and any further relevant treatment including Laser Therapy. You authorise Three Shires Veterinary Physiotherapy to  conduct physiotherapy as needed.

Vet reports

Three Shires Veterinary Physiotherapy will supply vet reports after initial consultation and throughout the treatment programme as needed. A final report will be issued upon discharge from the physiotherapy programme. These will be supplied by email.

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