Registration

This form is ONLY for clients who have an upcoming appointment scheduled with us. Please complete this form to register yourself and your pet(s) with Acadia Vet Clinic. We look forward to seeing you soon!

Name of Owner *

First

Last

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Primary Phone *

Alternate Phone

Email *

Spouse/Partner

Phone

Email

Preferred Contact Method *

Phone
Email

How did you hear about us? *

Who referred you, we'd love to thank them!

If Other, please explain

Patient Information

Pet's Name *

Species *

Cat
Dog
Other

If Other, please elaborate

Breed

Color *

Age

Sex *

Female
Spayed Female
Male
Neutered Male

Microchip Number (if applicable)

Relevant Medical History (allergies, current medication, current health conditions, etc)

Other pets in the household? *

Yes
No

Would you like to add information for another pet? *

Yes
No

Pet's Name *

Species *

Cat
Dog
Other

If Other, please elaborate

Breed

Color *

Age

Sex *

Female
Spayed Female
Male
Neutered Male

Microchip Number (if applicable)

Relevant Medical History (allergies, current medication, current health conditions, etc)

Would you like to add information for another pet? *

Yes
No

Pet's Name *

Species *

Cat
Dog
Other

If Other, please elaborate

Breed

Color *

Age

Sex *

Female
Spayed Female
Male
Neutered Male

Microchip Number (if applicable)

Relevant Medical History (allergies, current medication, current health conditions, etc)

Please upload any of your pet's records that you may have

Click or drag files to this area to upload. You can upload up to 5 files.

Authorization

I hereby authorize the veterinarian to examine, prescribe for, or treat the above described pet. I assume responsibility for all charges incurred in the care of this animal. I also understand that these charges will be paid at the time of release and that a deposit may be required for surgical treatment or hospital treatment. *

I have read and agree

Signature of Pet Owner *

Clear Signature

Date *

New Client Form

Registration

Patient Information

Authorization

Contact Info

Hours

Location

Ready to come see us?

Call us today to schedule your next appointment at Acadia Veterinary Clinic and Pet Rehabilitation Centre!