Outpatient appointment request form

Please complete the form below and a member of our reception staff will contact your client to arrange an appointment within 48 hours. 

We are currently unable to offer Outpatient MRI due to increased demand from referral cases. We are still taking cases as neurology referrals as normal and are happy to discuss other appropriate imaging options for those patients affected. We apologise for any inconvenience.

Please note: there is currently a two week waiting list for Outpatient CT scans.

For full details and prices see our Outpatients page.

This form must be completed by a Veterinary Practice only, it is not for use by the general public.

ONCE YOU HAVE SUBMITTED YOUR REQUEST PLEASE CALL US ON 0117 394 0513 OR 0117 394 0514 TO ENSURE WE HAVE RECEIVED IT.

 

Please provide a brief description of the patient's relevant clinical history.
Please attach any supplementary history or blood results you feel would aid our interpetation of results. Alternatively you can email these to sah@langfordvets.co.uk
Date blood sampled
If you are referring a case for endoscopy you must complete this field
If you are referring a case for endoscopy you must complete this field
If you are referring a case for endoscopy you must complete this field
If you are referring a case for endoscopy you must complete this field