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?*

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

General Information

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.

If you can not see your own vet, please tell us why are you coming to us and how urgent this is.

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

Is your pet a dog, 1-8 years old, docile temperament, 55+ pounds and would you like to have them join or know more about our blood donor program?

Check out more info on our website, or reach out to us for further information. https://roncesvallesanimalhospital.com/blood-donor-information/

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)*

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 any signs of fear, stress, anxiety or aggression during veterinary visits?*

If yes, please contact us prior to your appointment date to receive a calming package. This will ensure we can complete a thorough physical exam and avoid having to reschedule your appointment if we are unable to.

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

Social Media

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.*

Please provide your Instagram handle if you'd like us to tag you in posts directly related to your pet.

How did you hear about us?*

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New Client/Patient Registration Form