New Client Form

Full Name *

Preferred pronoun

Email Address *

Phone Number

Address*

Unit Number (if applicable)

City

Province*

Postal Code

Do you have a preferred language of communication?

Name of secondary owner (if applicable)

Secondary owner contact number (if applicable)

A secondary owner is also authorized to make medical decisions, and once added to file, they cannot be removed without their consent*

Yes, I understand
I do not wish to add a secondary owner

Pet's Name *

Your pet's species

Your pet's breed

Reproductive Status*

Your pet's age

Date of Birth (if known)

Pet Colour*

Please attach a photo of your pet for our files

Has your pet ever been seen by another veterinarian? If so please provide us with the name of the clinic and if the records are under your information so that we can request them. If they are under a breeder, please bring the records to your appointment.*

If you would like to attach any medical records you have for your pet, please do so here

Additional Medical Records

May we share your pet's photo on social media?*

Yes
No

Does your pet have an Instagram account?

Would you like access to our client exclusive MyVetStore? We provide free shipping on orders over $100 and 5% off on recurring orders. Creating an account is completely free!*

Yes
No

What type of food does your pet eat and how much? (Please include the brand name and variety if possible)*

Please elaborate on any of the points above, or add any information you'd like to make the veterinarian aware of

I confirm that I am 18 years of age or older, and the legal guardian of the animal described above.*

Yes
No

Note: Verbal or physical aggression or abusive behaviour of any sort toward staff members will result in immediate termination of care at this hospital*

Yes, I understand

The Canadian Anti-Spam Legislation (“CASL”) prohibits the sending of any electronic messages that are commercial in nature unless the sender has received the recipients' express consent prior to sending the message. Our practice therefore requires your written consent to send you any electronic messages. While most of our communications are related to your pet’s health, some may contain commercial activities such as promotions, special events, or fundraising activities. Please note that if you do not consent, you will not receive ANY communications from our practice on any matter.

We also like to feature patients on our social media account(s), whether it be a success story, an interesting visit or the animal is just too cute not to. For us to responsibly take these videos and/or pictures we need to be granted your permission to use them on our social media account(s). Please keep in mind that your consent can be revoked at any time, but images and videos used during active consent will remain, though no further use of the images or videos will take place. A removal request can be made and will be reviewed, depending on the video and/or image we will try and remove it as requested but, in some cases, removal will not be possible, so please bear that in mind when consenting.

Note that phone calls must be allowed as that will always be the first contact method used in an emergency. Also, if you opt-out of email, you will not receive invoices, estimates, or reminders.

New Client Form

New Client Form

ABOUT YOU

ABOUT YOUR PET

ABOUT YOUR APPOINTMENT

CONSENT FOR COMMUNICATION & MEDIA USE

Newsletter	Yes No
Use of Pictures/Videos	Yes No