New Client Registration Form – Animal Hospital on Bell Farm Road

New Client Registration

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 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). The required sections have a red * asterisk.

CLIENT INFORMATION
Name*
First Last
Spouse
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone*
Work Phone
Cell 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:
Date Format: MM slash DD slash YYYY
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:
Date Format: MM slash DD slash YYYY
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:
Date Format: MM slash DD slash YYYY
Previous medications/conditions or concerns:
Current Diet:
Name of Previous Veterinary Hospital:
May we call to request previous medical records?*
- Yes
- No
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 clinic's MyVetStore as a client of Animal Hospital On Bell Farm Road, at submission of new client forms.
I agree.

Our Location

115 Bell Farm Rd
Suite 110
Barrie, ON
L4M 5G1

Directions

Hours

Mon: 9 am – 8 pm
Tue: 9 am – 8 pm
Wed: 9 am – 4 pm
Thur: 9 am – 8 pm
Fri: 9 am – 2 pm
Sat: 9 am – 4 pm
Sun: Closed

Connect With Us

Phone: 705-881-9980
Fax: 705-881-2475
Email: info@ahobf.ca