New Client Request Form

PRIMARY CONTACT

Full Name *

Email Address *

Address *

City *

Province *

Postal Code *

Main Contact # *

Cell *

Other Contact #

Work

Do you give consent for us to email you? *

Yes
No

For appointment confirmations and general correspondence do you prefer *

Email
Phone
No preference

How did you find out about us?

SECONDARY CONTACT

By filling in this information, you are authorizing this person has permission to make any and all medical decisions for this pet.

Full Name

Home Phone Number

Cell Phone Number

Work Phone Number

PET INFORMATION

Pet's Name *

Date of Birth *

Sex *

Breed *

Colour *

Add another pet? *

Yes
No

Diet (Name/Brand/Dry/Wet)? *

Current medications and/or supplements *

Does your pet have any medical conditions we should be aware of?

Does your pet experience anxiety/stress while visiting the vet clinic? If so, what strategies have worked well to support your pet in hospital in the past?

Previous Vet Clinic *

Is your pet up-to-date on their vaccines?

Yes
No
I don't know

Approximately what date was your pet's last vet appointment?

In an effort to be able to book your pet as a patient of our animal hospital, we ask that you have your pet's medical records transferred to us by email as soon as possible. Thank you.

If you have any notes regarding your pet's medical files, please leave them here:

Do you have pet insurance? *

Yes
No

We love taking pictures of all the wonderful pets we see here! If any photos are taken of your pet during their visits to our clinic, do you authorize us to share them with others on social media outlets such as Facebook and/or Instagram?

Yes
No

Security Question *

I HAVE READ AND UNDERSTOOD THE PRIVACY POLICY *

New Client Request Form

PRIMARY CONTACT

SECONDARY CONTACT

PET INFORMATION

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