New CLIENT/PATIENT Registration

New CLIENT/PATIENT Registration

We are pleased to announce that we are accepting new patients. To best care for our furry friends, we are accepting new patients in a gradual and conscientious structure to ensure we are providing quality care in a timely manner to both our existing and future patients. To facilitate this process, we kindly request clients to complete the form provided below. FOR EMERGENCIES PLEASE CALL (250) 564-1315
Pet owner name (must be over 18)*

First NameLast Name
Secondary pet owner name

First NameLast Name
Address*

Street Address

Street Address Line 2

CityProvince

Postal Code
Email Address*
Cell Phone
Home Phone*
Work Phone
Preferred Method of Contact*
Pet Information*

NameAge/GenderSpecies/Breed/ColourSpayed?/Neutered?
Pet Information

NameAge/GenderSpecies/Breed/ColourSpayed?/Neutered?
Pet Information

NameAge/GenderSpecies/Breed/ColourSpayed?/Neutered?
Is your pet insured?
Name insurance company if applicable
Previous veterinary clinics your pet has been to
Current and previous medical conditions +/- medications
Hospital Payment Policies:
- Full payment is required at time of service rendered
- Deposits are required for surgical, dental and hospitalization care
- Treatment plans and estimates will be provided
- Financing options are available via ScratchPay
- Methods of payment: cash, Visa, Mastercard, Debit, AMEX
Should be Empty: