Veterinary Referral Form

OWNER/PET INFORMATION:

REFERRER:

DETAIL:

DISEASE INFORMATION

* If your patient requires immediate transfer, please call us at 2408 2588 after submitting this form.

If you have any questions about how to categorize your patient's status, or if you would like to speak to a specialist directly, please call 2408 2588.

By submitting this form, we collect your personal data for the Purposes defined in the Personal Information Collection Statement. We may also use your personal data for direct marketing purpose, by providing you with information or materials we think may be useful or relevant to you, information about the products and services of VSH, and the latest promotional information of VSH, provided we have obtained your consent below.

Personal data provided by you will be used strictly in accordance with the Personal Information Collection Statement and Privacy Policy Statement.

By checking the box below, I consent to the use of my personal data by VSH and its third-party contractors or service providers for direct marketing purpose, by providing me with information or materials VSH considers useful or relevant, information about the products and services of VSH, and the latest promotional information of VSH.