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 complete this form as fully as possible prior to your first appointment which will help expedite the registration process and give us valuable insight in providing optimal care for your pet(s). The required sections have an *asterisk.

Owner's Full Name *

Email *

Address *

City *

Province *

Postal Code *

Cell Phone *

Name of cell phone carrier *

Home Phone

Work Phone

Do you consent to Parkwest Pet Clinic contacting you by e-mail or SMS text message for the purpose of medical care for your pet(s)? *

Yes
No

Do you give Parkwest Pet Clinic permission to take photos of your pet(s) to post on the clinic's social media pages? *

Yes
No

Co-Owner/ Emergency Contact

Co-Owner Phone

Relationship To Owner

Add another co-owner/emergency contact?

Yes
No

PET INFORMATION

Pet's Name *

Species *

Breed (if known)

Colour *

Age *

Sex *

Does your pet have a microchip/tattoo?

If yes, please enter the microchip# or tattoo details.

Medication / Supplements

Please note, an exam is required for any refill of medication for new clients/patients.

Name and phone number of previous veterinary care provider:

Does your pet have insurance? *

Yes
No

Would you like to add another pet?

Yes
No

Additional Comments

New Client Registration Form

OWNER INFORMATION

CO-OWNER INFORMATION

PET INFORMATION

New Client Registration Form

OWNER INFORMATION

CO-OWNER INFORMATION

PET INFORMATION

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