Fillable UCDVH Advice Call Request Form Fillable V3

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UCDVH Advice Call Request Form Fillable V3

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(*Note: The Vet Hub contact information is
for referring veterinarians only and should
not be given to clients)
UCD Veterinary Hospital
University College Dublin, Belfield, Dublin 4
Direct Vet Hub* Tel (01) 716 6200
Direct Vet Hub* Email: vethub@ucd.ie
General Hospital number: (01) 716 6002 Fax (01) 716 6005
Web: http://www.ucd.ie/uvh
For UCD use only:
Name of clinician returning advice call:______________________________________ Date:____________________
Advice Request Form Date:
Veterinary
Surgeon’s Name
Practice Name
Town
Phone number(s)
Work:
Mobile:
Time most likely to be available to take advice call?
(Please inform your staff that you are expecting a call from UCD.)
Advice topic
Are you likely to refer this patient to the UCD Veterinary Hospital? (yes/no)
Please indicate if advice is required urgently (yes/no):
Patient details (if relating to a specific patient):
Client contact number**
Species
Age
Sex
Breed
Colour
Weight
Provide Summary of
Laboratory reports: YES NO
Radiographs taken: YES NO
**Client name/contact number will only be used for registration purposes if the patient is subsequently referred in to the UCD Veterinary Hospital.
Question details:
Your main question
(e.g. advice on
approach/management/
specific treatment)
Other comments
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UCDVH Advice Call Request Form Fillable V3

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Completed 13 November 2021

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