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Client Booking Form

:: Please complete all details in this form and submit. We will be in touch shortly. Thank you.
:: Dermatology customers please call for bookings on 130027546838
:: Animal Eye Services customers please call for bookings on (07) 3341 1981
:: Service Details:
Location:: Underwood PracticeCarrara PracticeJindalee Practice
Service Referred to:: MedicineCardiologyDentistrySurgeryDermatologyPhysiotherapyOncologyOpthalmology
VSS Vet Referred to:
:: Pet Details:
Pet Full Name:
Breed:
Species:
Age:
Sex:
:: History:
Patient History:
Treatment to date:
:: Please identify in the checklist below, all referring documents uploaded. Please note that we cannot confirm a booking without first receiving all appropriate referring documentation.
Upload Referral Docs:
Please Select:: Laboratory ReportsRadiographsPatient HistoriesOther
Other Continued:
:: Referrer's Details:
Referring Veterinarian:
Referring Clinic:
:: Owner's Details:
Full Name:
Address:
Telephone:
Fax:
Email:
Required:: We authorise Veterinary Specialist Services to contact IDEXX and QML directly to obtain pathology results
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Carrara

104 eastlake st

Underwood

cnr Logan and Lexington rds

Jindalee

34 Goggs rd

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