New Patient Form

OWNER INFORMATION

Full Name *

Phone Number *

Address *

City *

Province *

Postal Code *

Email Address *

How did you hear about us? *

Is there anyone we can thank for the referral? *

What is the name of your regular clinic, if applicable:

Have you left your regular veterinarian? If so, why?

Do you give us consent to post your pet(s) on our social media? *

Yes
No

Do you have pet insurance? *

Yes
No

CO-OWNER INFORMATION

Co-owner/Emergency Contact Full Name

Secondary Contact Phone #

PET INFORMATION

Pet's Name *

Sex *

Date of Birth or Age *

Breed *

Colour *

Date of last vaccines *

For cats:

Indoor
Outdoor

Presenting Problem/Concern: *

Please tell us briefly about any previous medical problems your pet has had. E.g. Past surgeries, illnesses, allergies *

Is your pet currently on any pre-visit interventions (medications): *

What is your pet’s interest for a positive visit? (treats, quiet, being outside): *

What triggers your pet to be stressed? (temperature taking, carrier, injections): *

What is the preferred location of exam? (inside carrier, outside): *

What type/brand of food are you feeding:

On arrival to your appointment we require presentation of government issued photo identification for verification. To keep costs of professional services at a minimum, all fees must be paid in full at the time of service. A deposit of 75% is required on all pets that must be hospitalized for laboratory testing or treatment. No billing credit is available through our office or over the phone. We accept: Cash, Interac, Mastercard, Visa, American Express, E-Transfer, Medicard.

Security Question *

I HAVE READ AND UNDERSTOOD THE PRIVACY POLICY *

New Patient Form

OWNER INFORMATION

CO-OWNER INFORMATION

PET INFORMATION

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