Referral Form Step 1 of 4 25% Please call to discuss your case prior to transfer. The patient transfer form and clinical records must be sent prior to transfer. All transferring and referral cases will have a consultation with the duty vet prior to hospital admission. Costs will be discussed with the client during this consultation.WAHVC Contact Confirmation(Required) YES | Called after 6:30pm weeknights or 12pm Saturday (04 473 7545) You have called WAHVC to discuss the patient transfer and confirm acceptance PRIOR to sending the patient / patient details. Patient and Owner DetailsAnimal's Name(Required)Owner's Name(Required) First Name Last Name Owner's Contact Phone Number(Required) Referring Clinic InformationReferring 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) Hours : Minutes AM PM AM/PM Referring Veterinarian Email(Required) Pet's Health InformationReason for Transfer(Required)Current Medications(Required)MedicationDoseLast Administered Add Remove(click + to add more if applicable)Is the Patient on Fluid Therapy?(Required) Yes No Please Specify Current Fluid Therapy Add Remove(click + to add more if applicable)Diagnostics(Required) Blood Tests Radiographs Urinalysis N/A Other Select AllPlease check which diagnostics you are attaching, check N/A if none provided. Upload Diagnostics Drop files here or Select files Max. file size: 100 MB. Upload all files here Patient ResponsibilityPatient 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.