Register Your Pet

CLIENT INFORMATION

Client Name/Owner *

Secondary Name/Owner *

Only the above-named individuals can access patient information, make care decisions, and discuss your pet with our team. We adhere strictly to client/patient confidentiality and will not discuss patient details with those not listed on file. *

I acknowledge

Initials *

Address *

City *

Province *

Postal Code *

Phone Number *

Secondary Phone Number

Email Address *

Do you consent to receive appointment reminders and updates via email? *

Do you consent to us sending photo updates of your pet and using their photo on our social media platforms? *

PATIENT INFORMATION

Pet's Name *

Your pet's gender *

Your pet's species *

Your pet's breed *

Date of Birth/ Estimate of Age *

Coat Colour

Previous Vet Hospitals Visited (If Applicable)

Please forward all previous veterinary records to info@harbourcitiesvet.ca prior to your pet's appointment.

Is your pet on any continuous medications/supplements? This includes parasite prevention.

Tell us a little about your pet's everyday life

Any medical/health concerns you would like us to make a note of?

Do you live in a multi-pet household? *

CODE OF CONDUCT: Our team members are here because they want to help you with your furry friends. To best support them in this, it is imperative that all communications are respectful in nature. Obscene, abusive, or rude behavior towards any member of our team, or another client, is not acceptable. We reserve the right to discontinue services to anyone who exhibits behavior of this nature.

Yes, I have read and understand the 'Code of Conduct' *

PAYMENT POLICY: Payment is due at the time services are rendered. Acceptable payment methods include cash, debit, Mastercard, Visa and e-transfer. Harbour Cities Veterinary Hospital does not bill for services. If you have payment concerns - please speak to a member of the reception team about third-party payment options prior to your pet receiving care.

Yes, I have read and understand the 'Payment Policy' *

Signature *

Security Question *

I HAVE READ AND UNDERSTOOD THE PRIVACY POLICY *