New Client Registration Form

Thank you for considering our hospital as your pet’s provider of veterinary services. We are dedicated to maintaining the health of your pet and look forward to many future years together. Please complete this from as fully as possible prior to your first appointment which will help expedite the registration process and give us valuable insight in providing optimal care for your pet(s). The required sections have a blue * asterisk.

We require a deposit of $50.00 at the time of scheduling for all new client appointments as this reduces no-shows and last-minute cancellations that impact our ability to care for current and new patients. This deposit will be applied to your first visit. If you need to reschedule or cancel your appointment it must be done a minimum of 24 hours prior to the scheduled appointment, or your deposit will be forfeited.

Client Information
Salutation
Name*
First Last
Address*
Street Address Address Line 2 City Province / Territory Postal Code Country
Phone*
Mobile Phone
Email*
Enter Email Confirm Email
Co-owner's Name & Contact #
Salutation
Name
First Last
Phone
Mobile
Email
Enter Email Confirm Email
How did you find out about our practice?
- Clinic Location
- Personal Referral
- Internet Search / Website
- Yellow Pages
- Clinic Sign
- Newspaper / Print Media
- Other
If Other, please specify:
If Personal Referral, is there someone we can thank for this referral?
Pet Information
Pet's Name*
Species*
or if other species
Breed (if known)
Colour
Date of Birth or Age (if known)
Special Identification (tattoo, microchip, etc.)
Sex
Previous Veterinarian or Clinic
Pet Insurance Company and Policy Number

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New Client Registration Form

Client Information

Co-owner's Name & Contact #

Pet Information

CONTACT INFORMATION

CLINIC HOURS

APPOINTMENTS