New Client/Patient Form

***New Clients – Register with this form today to be added to our waitlist.***

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 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.

New Client/Patient Form

Patient Information

Hospital Information