New Clients

New Clients

As a new client at Companion Veterinary Clinic there are some things about you we need to know. Please fill out the information below with the confidence that we will never sell, give away or use your information for anything other than communicating with you (no spam though). Your details are safe with us.

This information will make your check-in process much quicker when you arrive.

New Client Form

Appointment

Have you made an appointment yet?  Yes No

  • If no, we’ll be contacting shortly to set up an appointment date and time
  • If yes, please write the date and time.

Appointment: Date Time


Contact Information

How did you hear about us?

Full Name (required)
Email Address (required)
   

Address

Address 2

   
City/Town
Postal Code
   
Primary Phone (required)
Secondary Phone
   

Would you like to receive our newsletter with pet health information, promotions and chances to win great prizes for your pet?


Pet #1

Name: Breed:
       
Color: Species:
       
Age: Gender:  Male Female
       
Birthday: Status:
       
Date of last visit:    
       
What would you like to discuss with the vet?
       

Pet #2

Name: Breed:
       
Color: Species:
       
Age: Gender:  Male Female
       
Birthday: Status:
       
Date of last visit:    
       
What would you like to discuss with the vet?
       

If you haven’t booked already we’ll call you soon to arrange a date and time.