New Client Enrolment Form

Greenbank Animal Hospital

Nepean-Rideau Veterinary Professional Corporation

3160 Greenbank Rd

Nepean, ON K2J 4H6

(613) 825-2902

We are proudly accepting new clients and patients at this time. Please complete and submit the intake form and our reception staff will be in touch about booking an appointment as soon as possible. Thank you for your interest in joining the Greenbank Animal Hospital family.

Owner name*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

I verify that I am the owner/acting guardian of the animal(s) described below. I assume responsibility for this animal and I have the authority to execute consent.*

I confirm

If you were referred by someone, what is their name?

If you need a file transferred from another clinic, what is the name and phone number or email of that veterinary clinic (or state none)?*

Reason for transfer*

New puppy or kittenNew to the areaOther

Do you have a preferred veterinarian at our clinic?

Pet #1 information: Name*

Pet's Date of Birth*

Species*

Breed

Colour

Pet's sex*

MaleMale/neuteredFemaleFemale/spayed

Pet #2 information: Name

Pet's Date of Birth

Species

Breed

Colour

Pet's sex

MaleMale/neuteredFemaleFemale/spayed

Pet #3 information: Name

Pet's Date of Birth

Species

Breed

Colour

Pet's sex

MaleMale/neuteredFemaleFemale/spayed

Please allow 2-3 business days for your application to be processed. A staff member will reach out to you directly to confirm enrolment. Please be advised that we are accepting new clients while spots are available and submitting this form does not guarantee enrolment with the clinic. Thank you for your interest in joining the Greenbank Animal Hospital family.

Please verify that you are human*