New Client Registration

CLIENT INFORMATION

Full Name *

Email Address *

Address *

City *

Province *

Postal Code *

Primary Phone Number *

Secondary Phone Number

Emergency Contact Full Name *

Relationship *

Phone Number *

Pet's Name *

Species *

Breed *

Date of Birth or Approximate Age *

Gender *

Colour/Markings *

Microchip Number (if applicable)

Previous Veterinary Clinic (if applicable)

Does your pet have any known allergies? If yes, please list. *

Is your pet on any medications? If yes, please list. *

Any previous surgeries or medical conditions? If yes, please list. *

Current Diet (Brand & Type) *

Is your pet *

Indoor
Outdoor
Both

Do you give permission for us to request medical records from your previous veterinarian? *

Yes
No

Do you consent to receiving email/text updates about your pet’s health, appointment reminders, and clinic updates? *

Yes
No

Client Signature *

Today

Security Question *

I HAVE READ AND UNDERSTOOD THE PRIVACY POLICY *