Client Care Center

new patient registration

Save time and fill our your new patient registration form online! We look forward to seeing you and your pet soon.

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Pet Owner's Name

First

Last

Spouse/Significant Other/Co-Owner Of Your Pet

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Home Phone

Work Phone

Mobile Phone

Spouse/Significant Other Phone

E-mail

The emergency contact you choose must have the ability to make decisions regarding your pet's care if you are unreachable by phone.

Emergency Contact Name

Emergency Contact Phone

Emergency Contact Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

How did you hear about us?

Patient Information

Pet's Name

Pet Type

Colour

Markings

Breed

Pet's Date of Birth

Pet Sex

Is your pet fixed?

Tattoo

Microchip #

Previous Veterinary Clinic:

Do you have pet insurance?

Consent to request medical records from previous veterinary clinic?

Consent to release pet’s vaccine history to a groomer, kennel, or animal shelter if requested?

Consent to release your phone number if your pet is found at large?

Last Veterinary Treatment:

Prior Vaccine Reactions?

Any known drug allergies or reactions?

Prior illness or surgery?

Please list all current medications.

Diet restrictions or supplements?

Reason for visit?

Please click here to read our updated terms and conditions on our clinic policies page.

I agree to the terms and conditions as outlined under the clinic policies.

I Agree

Phone