New Patient 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 form as fully as possible prior to your first appointment which will help expedite the registration process and give us valuable insight into providing optimal care for your pet(s). The required sections have an *asterisk.

CLIENT INFORMATION

Full Name *

Email Address *

Address *

City *

Province *

Postal Code *

Home Phone

Cell Phone #1 *

Work Phone

Cell Phone #2

Please enroll me as a registered member of the hospital website *

Yes
No

As a registered member I will be able to:

Check pets’ vaccinations status
Request appointments/boarding
Purchase medication/food refills
Make better decisions about pets’ health & well-being
Discover ways to help my pet live a longer & healthier life
Inform if pet is lost/deceased
Notify of address change

Please subscribe me to the FREE Pet Living & Wellness Newsletter *

Yes
No

Please note: Your privacy is important to us. All information received in all forms and through other communications is subject to our Privacy Policy.

PET INFORMATION

Pet's Name *

Your pet's breed

Your pet's age *

Date of birth *

Your pet's species

Sex *

Would you like to add another pet?

Yes
No

ACKNOWLEDGMENT

All payments are due at the time of services rendered. We accept cash, checks, all major credit cards, and Care Credit which can be approved in as little as 10 minutes.

I have read and understand the above statements and agree to all terms therein.

Signature *

Security Question *

I HAVE READ AND UNDERSTOOD THE PRIVACY POLICY *

New Patient Registration Form

CLIENT INFORMATION

PET INFORMATION

ACKNOWLEDGMENT

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