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***New Clients – Register with this form today to be added to our waitlist.***
New Client/Patient Form
Thank you for giving us the opportunity to serve you. In order to provide you with the best possible service, please complete the following:
Name:
*
First
Last
Address:
*
Street Address
Address Line 2
City
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Province
Postal Code
Home Phone:
*
Cell Phone:
Work Phone:
Email:
*
Enter Email
Confirm Email
Place of Employment:
Name of Spouse/Partner:
First
Last
Home Phone:
Cell Phone:
Work Phone:
Spouse E-mail:
Enter Email
Confirm Email
Spouse Place of Employment:
Patient Information
Patient's Name:
*
Breed:
*
Gender:
*
Birth Date:
*
Colour:
*
Spayed/Neutered?
*
Microchip:
Prior Medical History:
Previous Veterinarian/Animal Hospital's Name:
Does your pet have any chronic illnesses or conditions we should know about? If yes, please describe:
Do you have pet insurance?
*
Please provide your pet’s vaccination history (last 3 years):
Reason for today's visit:
*
Hospital Information
Why did you choose to come to our hospital?
*
To prevent the spread of infectious diseases and parasites, hospitalized patients must be current with respect to all vaccinations and be free of internal and external parasites. When needed, hospital staff will immunize and provide parasite control of animals in the hospital.
Full payment is required at the time services are rendered or upon discharge if the animal is hospitalized.
A deposit may be required for major medical or surgical cases.
If you have any special concerns regarding cost limits or services to be provided, please let us know at the time of admission.
Otherwise we are authorized to use our best judgement in the treatment of your pet.
Please be advised that cancellation of any non-surgical appointment within 24 hours will result in a cancellation fee.
For surgical appointments we require 72 hours notice, otherwise there will be a surgical cancellation fee.
Who is responsible for this account?
*
Address (if other than owner):
*
At this time, we accept VISA, Mastercard and Debit as well as Interac E-Transfer.
We offer a 10% discount for seniors and disabled clients. Proof is required to qualify for the discount.
Consent
*
By submitting this form electronically, I, the undersigned, being 18 years of age or older, am the owner or authorized representative of the owner of the animal(s) described above and am authorized to make decisions regarding its care.
Home
About Us
Meet Our Team
Take A Tour
Careers
Services
Hospital Policies
COVID-19 Policy Statement
Missed Appointment Policy
Resources
Download Our App
Pet Health Library
How-To Videos
Pet Health Checker
Pet Insurance
News
Pet Food Recalls
Product Recalls
Travel and Export
Helpful Links
Emergency Patient Care
Contact Us