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 from 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 a red * asterisk.

Owner's Name
Salutation
Name*
First Last
Co-owner's Name & Contact #
Salutation
Name
First Last
Phone
Address
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
How did you find out about our practice?
- Clinic Location
- Personal Referral
- Internet Search / Website
- Clinic Sign
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
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
Please use the following box to give us any other relevant information about your pet
Subscribe to Our Mailing List?
- Yes!

HOURS OF OPERATION

Monday	8:00am – 5:00pm
Tuesday	8:00am – 5:00pm
Wednesday	8:00am – 5:00pm
Thursday	8:00am – 5:00pm
Friday	8:00am – 5:00pm
Saturday	Closed
Sunday	Closed

For all after hours emergencies please contact:

Smart.Vet: (virtual care) 647-695-5411

Alta Vista Animal Hospital: 613-731-6851

Ottawa Veterinary Hospital:
accepting emergencies from 10am – 10pm 613-725-1182

Ottawa Animal Emergency Specialty Hospital:

613-745-0123

New Client Registration Form

Owner's Name

Co-owner's Name & Contact #

Address

Pet Information

HOURS OF OPERATION

CONTACT US