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Contact

Booking Request

Booking Request

Booking RequestJen Davis2025-09-02T17:42:54+10:00

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

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

No

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

No

Please upload any available history, reports or images

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

No

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

Phone

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

Victorian Veterinarian Rehabilitation Centre
2394 Plenty Road, Whittlesea, VIC 3757
03 9716 2495
vvrc@apiam.com.au

Does your pet need help?

Call us on 03 9716 2495
Email us at vvrc@apiam.com.au

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

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Booking Referral Form