New Client Registration Form We appreciate the opportunity to care for your pet and look forward to working with you to help maintain the health of your pet for many years to come. Please fill out the following form to help facilitate your registration upon arrival to our hospital for your initial appointment. Owner’s Information First Name * Last Name * Address Line 1 * Address Line 2 City * Province * Postal Code * Country * Contact Information Cell Number * Home Number Work Number Email Address * Confirm Email Address * Co-owner’s name and contact First Name Last Name Phone Number How did you find out about our Hospital Clinic Sign Internet Search Personal Referral Other, please specify... Please list the date and time of your appointment if scheduled Date of Appointment Time of Appointment Please use this area to share with us any information about yourself or family that you feel is relevant to your visit Patient Information Pet's Name * Species * Dog Cat Breed (if known) Colour * Sex * Male Male Neutered Female Female Spayed Date of Birth (if known) Microchip Number Previous Veterinary Practice/Veterinarian name (if any) Date of last vaccines (if known) Which Vaccines were administered (if known) Is your pet on any medications or supplements? Yes No If so, please list: Does your pet have any allergies or medication reactions? Yes No If so, please explain: Please list any current or previous health conditions Would you like to opt-in to receiving appointment and vaccine reminders via email/text message? *Please note if you opt-out you will not receive any reminders from our clinic. Yes No Would you like us to sign you up to access our online vet store? Yes No New Patient Registration Form If you are an existing client of our hospital, please register your new arrival with us by filling out the following form. If you are a new client, please fill out the "New Client Registration Form" above. First Name * Last Name * Email Address * Phone Number * Patient Information Pet's Name * Species * Dog Cat Breed (if known) Colour Sex * Male Male Neutered Female Female Spayed Date of Birth (if known) Microchip Number Previous Veterinary Practice/Veterinarian name (if any) Date of last vaccines (if known) Which Vaccines were administered (if known) Is your pet on any medications or supplements? Yes No If so, please list: Does your pet have any allergies or medication reactions? Yes No If so, please explain: Please list any current or previous health conditions Prescription Refill Please allow 24 hours for order processing. Once your order has been completed we will contact you via email or phone call to inform you that it is ready for pick up. If you cannot wait 24 hours to pick up your pet’s medication please call the hospital. Please note: If we expect a delay in filling the prescription or if we are unable to refill your pets medication based on the medical history, we will call you to further discuss the situation. First Name * Last Name * Email Address * Phone Number * Pet Name * Drug Name * Strength/Dosage * Quantity * Additional Comments Preferred method of confirmation Email Phone Food Order Request Please allow for up to 3 business days for your food order to be available for pick up. Once the order has been received we will email you a confirmation with an estimated time for pick up. A second email will be sent once the order is ready. First Name * Last Name * Email Address * Phone Number * Pet Name * Food Name * Size of Bag / Quantity of Cans * Additional Comments Preferred method of confirmation Email Phone Travel Forms If you are planning on traveling to another country with your pet, certain requirement must be met and the proper documents must be obtained prior to travel. The requirements and the documents needed vary depending on where you are traveling and we recommend that you contact the country you are visiting in order to obtain the proper forms and import requirements. Below is a list of links that may help in your search: Canadian Food Inspection Agency Information and forms for countries frequently visited Australia Step by Step Guides United States of America Bringing an Animal into The United States Client Survey At North Woodbridge Veterinary Hospital we strive to meet the expectations of our clients. In order to better understand and meet the needs of our clients and patients please fill out the following confidential questionnaire. Do you feel as though your needs and concerns were addressed during your visit?* Do you feel as though the needs and concerns of your pet were addressed during your visit?* What can we do to help make your next visit a more pleasant one?* Name and pet's name (optional)