Wellington After Hours Emergency Vet Clinic

Please complete and email the patient transfer form and clinical records for any cases requiring potential transfer. Before sending the patient, kindly call the clinic after 6:30 PM on weekdays and after 12:00 PM on Saturdays to confirm acceptance of the transfer and discuss any further details

Patient and Owner Details

Animal's Name(Required)

Owner's Name(Required)

First Name Last Name

Owner's Contact Phone Number(Required)

Referring Clinic Information

Referring Clinic Name(Required)

The business name of the referring clinic

Referring Veterinarian Name(Required)

Referring Vet After-Hours Contact Number(Required)

What is the latest time you would like to be contacted?(Required)

:

Referring Veterinarian Email(Required)

Pet's Health Information

Reason for Transfer(Required)

Current Medications(Required)

Medication

Dose

Last Administered

(click + to add more if applicable)

Is the Patient on Fluid Therapy?(Required)

Yes

No

Please Specify Current Fluid Therapy

(click + to add more if applicable)

Diagnostics(Required)

Blood Tests

Radiographs

Urinalysis

N/A

Other

Please check which diagnostics you are attaching, check N/A if none provided.

Upload Diagnostics

Drop files here or

Max. file size: 100 MB.

Upload all files here

Patient Responsibility

Patient Assessed as Stable for Transfer(Required)

Yes

This ensures the patient can be moved without complications, prioritising their safety and well-being during the transfer process.

Responsibility of Costs(Required)

Yes

The client has been advised that they are responsible for all costs relating to treatment at WAHVC, and payment is expected at the time of patient discharge. You are welcome to discuss anticipated costs over the phone with WAHVC before the transfer.

Pet Collection / Location(Required)

Yes

The client has been advised of our address and that they are responsible for collecting their pet the following morning before 8 a.m. Monday through Friday and 9:00 a.m. Saturday.

Referral Form

Patient and Owner Details

Referring Clinic Information

Pet's Health Information

Patient Responsibility