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Patient referral

The form is dedicated to a VETERINARY DOCTOR who guides the patient. Complete it to the best of your knowledge. If necessary, attach additional files.

Fields marked with an asterisk (*) 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.

Ask the Patient’s owner to complete the Application. After receiving both the documents from the Patient Owner and the necessary referral from the attending physician, we will contact the Owner to arrange a consultation.

After the end of therapy in our Center, you will receive a set of documents from us that will allow you to continue the treatment of the patient in your facility.


    LEKARZ PROWADZĄCY:

    OPIEKUN:

    PACJENT:



    PLIKI:

    Dołącz plik (max. 3MB)

    Dołącz plik (max. 3MB)

    Dołącz plik (max. 3MB)

    Dołącz plik (max. 3MB)

    Dołącz plik (max. 3MB)

    Dołącz plik (max. 3MB)


    Jeśli potrzebujesz przesłać do nas więcej dokumentów, lub jeśli te posiadane przez Ciebie mają większy rozmiar, prześlij je do nas za pomocą WeTransfer (https://wetransfer.com) na adres 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.