New Client Registration Form – Animal Hospital on Bell Farm Road

CLIENT INFORMATION

Name*

First Last

Spouse

First Last

Address*

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

Home Phone*

Cell Phone

Work Phone

Email*

Enter Email Confirm Email

Please list any and all people whom we are authorized to speak with regarding any medical treatments, health issues, etc. regarding your pets, in addition to those listed above.

EMERGENCY CONTACT

Name*

First Last

Phone*

Are you elegible for a senior discount (over 64)?*

Yes
No

Can we send you reminders via email?*

Yes
No

How did you become aware of our hospital?

Patient Information #1

Pet's Name*

Breed (if known)

Date of Birth or Age (if known)

Colour

Sex/Spayed or Neutered

Microchip #:

Date of Last Vaccines:

Previous medications/conditions or concerns:

Current Diet:

Patient Information #2

Pet's Name

Breed (if known)

Date of Birth or Age (if known)

Colour

Sex/Spayed or Neutered

Microchip #:

Date of Last Vaccines:

Previous medications/conditions or concerns:

Current Diet:

Patient Information #3

Pet's Name

Breed (if known)

Date of Birth or Age (if known)

Colour

Sex/Spayed or Neutered

Microchip #:

Date of Last Vaccines:

Previous medications/conditions or concerns:

Current Diet:

Name of Previous Veterinary Hospital:

May we call to request previous medical records?*

Yes
No

May we take photos/videos of you pet to use for our social media?*

Yes
No

Cancellation and Late Policies*

For appointments, we require 24 hours notice for cancellation.

For dental or surgical appointments, we require 48 hours notice for cancellation.

Late for Appointment:
A grace period of 10 minutes will be permitted for unforeseen delays you may encounter while traveling to The Animal Hospital on Bell Farm Road for your pet’s appointment. If you arrive more than 10 minutes after your pet’s appointment start time, you will be asked to reschedule for a later date. This process helps ensure that pets arriving on time are seen in a timely manner.

Late Cancellations for Appointments (less than 24 hours notice):
1st cancellation: We will contact you to reschedule your appointment.
2nd cancellation: 50% of exam fee will be applied to your account.
3rd cancellation: A full exam fee will be applied to your account and every subsequent time without the 24-hour cancellation notice.

Late Cancellations (less than 48 hours notice) Surgical/Dental Appointments:
25% of your estimate/treatment plan will be applied to your account for not providing 48 hours notice.

No Show Policy:
No shows inconvenience pets that need medical care in a timely manner. No shows will be recorded in your file.
1st no show: We will contact you to reschedule your appointment.
2nd no show: 50% of exam fee will be applied to your account.
3rd and subsequent no shows: Full payment must be paid up front for the exam fee by means of a credit card to hold the appointment slot.

To cancel or reschedule an appointment you can contact us through any of the following options;
Call 705-881-9980
Text 705-410-2342
Email info@ahobf.ca

More information can be found by clicking this link:
Cancellation and Late Policies

I have reviewed and agree to AHOBF's policies.

Consent*

I hereby authorize the veterinarian to examine, prescribe for, and/or treat the above
described pet(s). I assume full responsibility for all charges incurred for 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. I further agree to be added to the hospital's MyVetStore as a client of Animal Hospital On Bell Farm Road, at submission of new client forms.

I agree.