New Veterinary Registration Form

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New Veterinary Registration Form

Owner's Name
Name*
First Last
Preferred Pronouns
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Day-Time Phone*
Evening Phone
Mobile Phone
Email*
Enter Email Confirm Email
Co-owner's Name & Contact #
Name
First Last
Phone
How did you find out about our practice?
- Clinic Location
- Personal Referral
- Internet Search / Website
- Yellow Pages
- Clinic Sign
- Newspaper / Print Media
- Other
If Other, please specify:
If Personal Referral, is there someone we can thank for this referral?
Please use this area to give us any other relevant information about yourself or your family
Pet Information
Pet's Name*
Species*
or if other species
Breed (if known)
Color
Date of Birth or Age (if known)
Special Identification (tattoo, microchip, etc.)
Sex
Previous Veterinary Practice (if any)
Previous Veterinarian (if any)
Date of last vaccines (if known)
Date Format: MM slash DD slash YYYY
What vaccines were given at this time
Is your pet on any medication or supplement?
- Yes
- No
If Yes, please list the medication or supplement
What food does your pet eat?
Does your pet have allergies or drug reactions?
- Yes
- No
If Yes, please list the allergies and reactions
Are there any current or past medical conditions of which we should be aware?
- Yes
- No
If Yes, please comment on the condition(s) and indicate if they are current or past conditions
Has your pet exhibited any signs of Fear, Anxiety or Stress at previous clinic/grooming/daycare settings?
Please use the following box to give us any other relevant information about your pet

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Location Hours

Monday	9:00am – 6:00pm
Tuesday	9:00am – 6:00pm
Wednesday	9:00am – 6:00pm
Thursday	9:00am – 6:00pm
Friday	9:00am – 6:00pm
Saturday	9:00am – 5:00pm
Sunday	9:00am – 5:00pm

Veterinary Clinic Hours Only. CLOSED ALL STATUTORY HOLIDAYS and Sundays of Statutory Weekends. By appointment only for both Veterinary & Grooming services. Grooming Hours differ - please contact the Grooming department for an appointment. AFTER HOURS EMERGENCY - CANADA WEST CRITICAL CARE - 604-473-4882 Note: Saturdays are open for completed order pick-up only.

Pet Health Checker

Use our Pet Health Checker tool to help you decide if your pet's symptoms require immediate attention, To also continue to monitor at home.