New Client Registration Form

Thank you for considering our hospital as your pet’s provider of veterinary services. We are dedicated to maintaining the health of your pet and look forward to many future years together.

Please note that this IS NOT an appointment confirmation, nor confirmation that you are considered an active client at our hospital.

Our team will reach out to you to schedule your pet’s visit.

CONTACT INFORMATION

Full Name *

Email Address *

Primary Phone Number *

Secondary Phone Number

Address *

City *

Province *

Postal Code *

Spouse / Co-owner's name

Co-owner's Phone Number

We occasionally post pet photos on social media, showing only the pet's name and picture. Do we have your permission to use photos of your pet?

How were you referred to our practice? *

PET INFORMATION

Pet's Name *

Species *

Breed *

Colour *

Date of Birth / Age *

Sex *

Last Vaccinations *

Name of previous veterinary practice *

Why are you booking this appointment? *

What is your preferred appointment date? *

By clicking yes, I agree to be held financially responsible for all pets in this file and to pay all fees, including services authorized by the individuals listed above. All fees are due at the time services are rendered. I understand that any medical or surgical procedure carries some risk and that it is not possible to guarantee a successful outcome of any procedure. This agreement will remain in effect indefinitely from this date, unless I notify West Hill Animal Clinic in writing, requesting to cancel the agreement. *

Security Question *

I HAVE READ AND UNDERSTOOD THE PRIVACY POLICY *

New Client Registration Form

CONTACT INFORMATION

PET INFORMATION

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