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Patient referral

The form is dedicated to a VETERINARY SURGEON. Please provide the following details about the animal and owner. If necessary, attach additional files.

Fields marked with (*) are mandatory.
After sending the Referral, you will receive a copy of it by e-mail. If you don’t receive it, please contact us.

Once the form has been completed you will receive confirmation by e-mail. If you don’t receive it, please contact us.The owner should complete the Application https://radioterapiaweterynaryjna.pl/zgloszenie-zwierzecia/.

After receiving both the document forms we will make the appointment directly with the client.

    VETERINARIAN:

    OWNER:

    PATIENT:



    FILES:

    Attach a file (max. 3MB)

    Attach a file (max. 3MB)

    Attach a file (max. 3MB)

    Attach a file (max. 3MB)

    Attach a file (max. 3MB)

    Attach a file (max. 3MB)


    If you need to send us more documents or larger size, please send them to us via WeTransfer (https://wetransfer.com) to the email: skierowanie@rtwet.pl

    The administrator of personal data is RTWet Sp. z o. o., NIP 7010712036. Using the form is tantamount to consenting to the processing of personal data contained in the form for the purposes necessary to sign up for consultation and possible treatment of the animal (in accordance with the Act of August 29, 1997 on the Protection of Personal Data ; uniform text: Journal of Laws of 2002, No. 101, item 926, as amended). The data will not be processed for other purposes and will not be transferred to third parties without your consent. You have the right to request access to your personal data, rectification, deletion or limitation of processing, as well as the right to object to the processing, as well as the right to transfer your data and submit a complaint to the supervisory body.