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03 9716 1221

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Referral and Booking Request

Referral and Booking RequestJen Davis2025-10-01T12:01:50+10:00

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This field is for validation purposes and should be left unchanged.

Type of Request

Vet Referral or Pet Owner Booking?(Required)

Vet Referral

Pet Owner Booking

Your Details

Vet Name(Required)

First Last

Clinic Name(Required)

Vet Phone(Required)

Vet Email(Required)

Client Details

Name(Required)

First Last

Phone(Required)

Email(Required)

Address

Street Address Address Line 2 Suburb State / Province / Region ZIP / Postal Code

Patient Details

Name(Required)

Species(Required)

Dog

Cat

Breed(Required)

Gender(Required)

Male

Female

Age/DOB(Required)

Presenting Issue:

Please explain your current concerns for your pet and what you would like us to address

Please specify the reason for this referral and any important case information:

Please upload the patient's medical history or email directly to vvrc@apiam.com.au

Drop files here or

Accepted file types: jpg, jpeg, png, pdf, Max. file size: 5 MB, Max. files: 5.

Referring Veterinary Clinic Information

Were you referred to us?(Required)

Yes

Referring veterinary clinic details:

Regular veterinary clinic details:

How did you find us?

Patient History

Has your pet had diagnostics (X-rays, CT, MRI, Ultrasound)?

Yes

Please upload any available history, reports or images or email directly to vvrc@apiam.com.au

Drop files here or

Accepted file types: jpg, jpeg, png, pdf, Max. file size: 5 MB, Max. files: 5.

Has your pet had surgery?

Yes

Please provide details of the surgery performed:

Booking a consultation

Our consultations are available from 10am until the last appointment at 2:15 on Wednesdays and Fridays.

Preferred day

Preferred time (between 10am and 2:15pm)

Preferred method of contact

Victorian Veterinarian Rehabilitation Centre
2394 Plenty Road, Whittlesea, VIC 3757
03 9716 1221
vvrc@apiam.com.au

Does your pet need help?

Call us on 03 9716 1221
Email us at vvrc@apiam.com.au

Or fill in our Referral and Booking request form and we’ll be in touch