Owner Information

Owner First Name *

Owner Last Name *

Owner Preferred Pronoun

Email *

Primary Phone *

Primary Phone Type *

If other, what type?

Secondary Phone

Secondary Owner / Authorized Agent Name

Secondary Owner / Authorized Agent Phone Number

Mobile Phone

Work Phone

Address *

City *

Postal Code *

How did you hear about us? *

Primary Care Veterinarian

Internet

Friend / Family

Community Event

Signage

Printed Publication

Radio

Other

Patient Information

Pet Name *

Birth Date / Age *

Species *

Breed / Other Species *

Colour

Vaccination Status *

Gender *

Spayed or Neutered? *

Does your pet have health insurance *

Yes

Date of last examination by a veterinarian

Date of Last Vaccinations

If yes, please provide insurance Company/Policy Number

Has your pet ever required medication during veterinary visits? If yes, please provide details and elaborate

Presenting problem, special needs, concerns *

Alternative Veterinarian Information

Please fill this section in if we are not your primary care veterinary hospital. By listing your primary care veterinarian, you are authorizing Admirals Walk Pet Hospital to release patient information to the primary care hospital or veterinarian.

Name of previous Hospital

Name of previous Veterinarian(s)

Appointment Policy

Please show up for your appointment 5 minutes early. If you arrive late for your appointment, your time spent with the doctor will be shortened. If you are more than 15 minutes late, your appointment will need to be rescheduled. If you do not show up for your appointment, you will be charged a deposit (cost of an exam) to rebook. If you book two pets, you will be required to leave a deposit of $118.00 (cost of one exam fee). If you need to cancel an appointment, please give 24-48 hours’ notice. If you are unable to give notice due to an emergency, your deposit will be kept and used towards a later appointment date.

By submitting this form, I hereby authorize Admirals Walk Pet Hospital to render medical care for my pet(s) as deemed necessary by the veterinarian. I understand that no guarantee can be given to the outcome of treatments and take it as my responsibility to comprehend any risks involved. I agree to pay for the cost of all services to which I consent to by written or verbal estimate. I understand that a deposit is required before diagnostics and treatments can be initiated and that payment in full is required prior to discharge of patient from Admirals Walk Pet Hospital.

Signature *

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New Patient Form

Owner Information

Patient Information

Alternative Veterinarian Information

New Patients Welcome