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11 Perth Road, Broadmeadow, NSW 2292
4957 7106
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Home
For Pet Owners
For Vets
Emergency
About
Careers
Fees
Events
Meet the Team
Our Giving
Acknowledgement of Country
Services
After Hours Care
Blood Donation
Imaging
Ophthalmology
Rehabilitation
Surgery
Veterinary Behaviour
Resources
Contact
Search
Home
For Pet Owners
For Vets
Emergency
About
Careers
Fees
Events
Meet the Team
Our Giving
Acknowledgement of Country
Services
After Hours Care
Blood Donation
Imaging
Ophthalmology
Rehabilitation
Surgery
Veterinary Behaviour
Resources
Contact
Home
For Pet Owners
For Vets
Emergency
About
Careers
Fees
Events
Meet the Team
Our Giving
Acknowledgement of Country
Services
After Hours Care
Blood Donation
Imaging
Ophthalmology
Rehabilitation
Surgery
Veterinary Behaviour
Resources
Contact
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Department
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CT
MRI
Behaviour
Ophthalmology
Rehabilitation
Surgery
Submitter Information
Who is completing this form?
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Pet Owner
Veterinarian
Reason for Submission
How can we help you?
(Required)
I would like to refer a patient.
I wish to discuss a case.
Referral Information
Veterinarian's Name
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Referring Practice Name
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Referring Vet Email
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Reason for Referral
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Provide the main reason for your referral here.
Client Name
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Last
Client Email (if known)
Client Contact Number
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Veterinarian Information
Vet/Contact's Name
Vet/Contact's Clinic
Please provide a brief overview of the case you wish to discuss
You will receive an email following your submission with a secure link to a drop box to upload any relevant information you wish to share with our team.
Vet/Contact's Email
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This field is required for your confirmation correspondence.
Vet/Contact's Phone
What is the best contact method to get back in touch with you?
Email
Phone
Alternate Contact
In the event we are unable to get in touch with you on a day that you are in the clinic, would you like to nominate a colleague that can discuss the case in your absence?
Please contact me only.
If I am unavailable, you may discuss the case with another vet/colleague.
Details of nominated vet/colleague (if required)
Client/Owner Information
Name
First
Last
Email
Phone
Reason for Contact
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Tell us a little about why you’re reaching out. The more details you give, the easier it is for us to help you when we get in touch.
Has your veterinarian recommended that you contact AREC?
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Yes
No - I am self-referring
Who is your pet's current vet clinic?
(Required)
Owner Information: If your pet has been seen by more than one clinic for the same condition, please list all clinics below. If you not given permission for AREC to obtain your pet's records - we will not contact the clinic.
Do you give permission for AREC to contact your regular vet to obtain you pet's medical records?
(Required)
Having your pet’s history means we can provide the best possible care. It also helps us access test results already done, so you don’t have to repeat them unnecessarily. Your information will only be used to support your pet’s medical care.
Yes - I give permission for AREC to contact my vet to obtain my pet's records.
No - I do not give permission for AREC to obtain my pet's records.
Pet Details
Pet's Name
(Required)
Please provide the last name that is listed with the vet clinic.
First
Last
Species
Canine
Feline
Other
Breed
Age
Sex
Female
Female Desexed
Male
Male Desexed
Data/File Upload
File Upload
Please upload any radiographs, history or information relevant to the patient here.
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Review and Confirm
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