New Client/Patient Registration Form

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New Client/Patient Registration Form

Thank you for choosing 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).

Are you an existing Client?*

If yes, are you looking to add a new pet to your existing file?*

Do you already have an appointment or would you like us to call you to make one?*

Owner's Name

Name

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone*

Mobile Phone*

Email*

Enter Email Confirm Email

Co-Owner's Name & Contact #

Name

First Last

Co-owner Phone

How did you find out about our practice?*

If Personal Referral, is there someone we can thank for this referral?

Reason for this appointment*

If you are coming because you are not able to see your own vet, please clarify if this is a new condition that is an emergency, or an ongoing condition.

Please contact any vet clinic you have visited in the past and ask them to forward your records to us via email. It is VERY important to have all previous records prior to your exam with us. List below all vet clinics that have seen your pet so we can make sure we have received all the records or follow up with them if needed. Our email is info@ronvet.ca

Pet Information

Pet's Name*

Species*

Breed*

Color*

Date of Birth or Age (if known)*

Special Identification (tattoo, microchip, etc.)

Gender*

Previous Veterinary Practice (if any)

Date of last vaccines (if known)

What vaccines were given at this time

Are there any current or past medical conditions of which we should be aware?*

If Yes, please comment on the condition(s) and indicate if they are current or past conditions

Is your pet on any medication or supplement?*

If Yes, please list the medication or supplement

Does your pet have allergies or drug reactions?*

If Yes, please list the allergies and reactions

Does your pet show signs of aggression?*

If Yes, do they need something to calm them for an appointment?

We are practicing as a fear free clinic and would like our patients to be as comfortable as possible while in our care.

Do you have pet insurance?*

If Yes, which company and what is your policy number?

Payment and Cancellation Policy *

For payments we are accepting all major credit cards, Debit, e-transfers or cash.

1. Cancellation within 24 hours of APPOINTMENT time - $37.50
2. Missed APPOINTMENT or more than 10 minutes late for scheduled appointment time - $52.50
3. Missed drop off or cancellation within 72 hours of SURGERY time - $250
We appreciate your consideration and understanding of this policy.

Terms*

I agree to the cancellation policy

At times during your pet’s visit, we may take pictures. Your consent here will act as authorization to use these pictures on Roncesvalles Animal Hospital Facebook, Instagram and social media pages.*

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New Client/Patient Registration Form

New Client/Patient Registration Form

Owner's Name

Co-Owner's Name & Contact #

Pet Information

Payment and Cancellation Policy *

In Case Of EMERGENCY

Address

18 Roncesvalles Ave. Toronto, ON M6R 2K3

Phone: 416-531-8282

Email: info@ronvet.ca

Hours of operation

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