Vet Referral | Amanda Butler Veterinary Physiotherapist

Why is a Vet Referral Required?

Prior to consultation, veterinary permission is required for physiotherapy treatment to commence in accordance with 'The Veterinary Surgeons Act 1966'. This ensures that physiotherapy is an appropriate treatment option and that we have all relevant medical history for your animal.

For Veterinary Surgeons

Please complete the form below to refer a patient for veterinary physiotherapy with Amanda Butler. Once submitted, we will contact the owner directly to arrange an appointment.

Alternatively, you can download the PDF version and email it to Abvetphysio@hotmail.com.

Download PDF Version

Veterinary Consent / Referral Form

Referring Veterinary Practice Details

Practice Name *

Referring Vet Name *

Practice Phone Number *

Practice Email *

Practice Address *

Owner Details

Owner Name *

Owner Phone Number *

Owner Email

Owner Postcode *

Patient Details

Patient Name *

Species *

Breed *

Age *

Sex *

Weight

Microchip No.

Medical Information

Diagnosis / Condition *

Relevant Medical History

Current Medication

Contraindications / Precautions

Recent Diagnostics (X-rays, Scans, Blood Tests)

Veterinary Consent

I, as the referring veterinary surgeon, give consent for the above named patient to receive veterinary physiotherapy treatment from Amanda Butler, qualified Veterinary Physiotherapist. I understand that a full report will be provided following each session. *

Veterinary Surgeon Name (Electronic Signature) *

Date *

Information for Animal Owners

How to Get a Vet Referral

If you'd like your animal to receive physiotherapy but don't yet have a referral, here's what to do:

Contact your vet - Speak with your veterinary practice and explain that you'd like to arrange physiotherapy treatment.
Request a referral - Ask them to complete our referral form. They can do this online (above), download the PDF, or simply provide consent via email or phone call to us.
We'll be in touch - Once we receive the referral, we'll contact you to arrange an appointment.

If you have any questions about the referral process, please don't hesitate to get in touch.

Vet Referral Form