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Welcome to the Royal College of Veterinary Surgeons
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Your details
First name
Last name
Email address
Telephone number
Your animal
Animal's name
Species
(Select)
Cat
Dog
Horse
Other (please specify)
Other (please specify)
Is your animal alive?
Yes
No
Was your animal euthanased (put to sleep)?
Yes
No
Veterinary professional's details
Name
Is this person a...
Veterinary surgeon
Veterinary nurse
Other (please specify)
Other (please specify)
Practice name
Practice address
Practice postcode
Your concern
Date of incident (if you are unsure, please estimate)
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Briefly outline your concerns
Have you raised your concerns with the practice?
Yes
No
Please describe what you feel would be a satisfactory outcome to your complaint
In the event that your concern is eligible for consideration by the Veterinary Client Mediation Service (the organisation administering the RCVS' Alternative Dispute Resolution service), do you consent to the RCVS sharing this form with them?
Yes
No
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