Referring a Patient for In-Person Assessment

To refer a patient to us for an in-person consultation simply fill in the form below. We will triage the case and contact the client directly to arrange an appointment.

We also now offer Remote Consultations. For more information please click here

Urgency

• This is an urgent referral

Urgent Consultations

We recommend submitting this case as a remote consultation instead. This is the most efficient way for us to quickly provide case management advice. See www.peteyecare.co.nz/remoteconsults for more information and the submission form

Which clinic would you like to refer to? *

• Hamilton (Small animal referrals, consultation fee $220)
• Cambridge (Equine referrals, consultation fee $500)

Our Wellington service has now moved to Hamilton. Please see www.peteyecare.co.nz/remoteconsults to learn about our remote consultation service

Animal's name *

Client's name *

Client's best contact phone number *

Client's email address

Referring veterinarian *

Referring clinic *

Best email address for the referring clinic *

For referral letters and other relevant communications about the case

Brief summary of the eye problem *

Does the patient have…

• Diabetes
• Addisons
• Neck/spinal/neurological disease
• Cardiac disease
• Renal disease
• Liver disease
• Immunological disease
• Anything else that may impact our care of the patient?

If so please give a brief summary of the relevant history below:

Is the patient on any medication for the eyes *

• Yes
• No

If yes please list below:

Is the patient on any other medications? *

• Yes
• No

If yes please list below:

Do you have any additional questions/comments about this case prior to referral?

Please upload the patient's clinical notes here:

Click or drag a file to this area to upload.

Maximum size for uploads here is 2MB. If your file is larger than this, or you have any issues, please submit the rest of this form and then email the notes to reception@peteyecare.co.nz (max 20MB/email)

Submit