Veterinary Referral Form

To make a behaviour referral please complete the form below and upload a copy of the patient’s clinical history (including any test results).

If you prefer, a copy of the form can be downloaded here and emailed to, along with the clinical history.

    Required fields are marked: *

    Practice Details

    Client Details

    Dog's Details

    * Gender

    * Is the dog neutered?

    * I acknowledge my consent for the above client and patient to be referred to Edinburgh Dog Behaviour with regard to behavioural issues.