New Client Enrolment Form

New Client Enrolment Form
Greenbank Animal Hospital

Nepean-Rideau Veterinary Professional Corporation

3160 Greenbank Rd

Nepean, ON K2J 4H6

(613) 825-2902
Welcome to Greenbank Animal Hospital!

Thank you for choosing us for your pet's veterinary care. We are dedicated to providing compassionate, high-quality medicine tailored to your pet's needs. We are proudly accepting new clients and patients at this time. To help us prepare for your appointment and ensure the best use of our time together, please complete and submit this intake form with as much detail as possible. If previous medical records are not yet available, this information will assit our team in understanding your pet's health history and current needs. 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 acknowledge that I am responsible for all charges incurred during my pet’s visit*

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

DogCatFerretRabbitGuinea PigHamsterRatMouseGerbilHedgehogChinchillaDegu
Breed
Colour
Pet's sex*

MaleMale/neuteredFemaleFemale/spayed
Pet #2 information: Name
Pet's Date of Birth
Species

DogCatFerretRabbitGuinea PigRatMouseGerbilHedgehogChinchillaDegu
Breed
Colour
Pet's sex

MaleMale/neuteredFemaleFemale/spayed
Pet #3 information: Name
Pet's Date of Birth
Species

DogCatFerretRabbitGuinea PigRatMouseGerbilHedgehogChinchillaDegu
Breed
Colour
Pet's sex

MaleMale/neuteredFemaleFemale/spayed
Do you already have a primary care veterinarian elsewhere?*

NoYes- please indicate the contact information below
If you need a file transferred from another clinic, what is the name and phone number or email of the veterinary clinic (or state none)?*
Reason for the appointment visit (annual, medical, etc)*
Please list any recent changes such as appetite, weight, drinking habits, energy levels, vomiting, diarrhea, coughing, sneezing, mobility issues, skin or coat condition.*
Please indicate your pet’s life style and behaviour (indoor, outdoor, both, rural, urban, hunting etc.)*
Please list any recent travel particularly out of province or country.*
Please list any behavioural concerns such as anxiety, aggression, fear of vet visits, inappropriate urination etc.*
Please indicate any known allergies (food, medication, vaccines, environmental, etc).*
Please indicate last known vaccines and dates including dhpp, leptospirosis, lyme, bordetella and rabies (dogs) or fvrcp, felv and rabies (cats).*
Please indicate any parasite prevention being used (brand, frequency and date last given).*
Please list any previous serious illnesses, injuries, or surgeries*
Please list any known chronic medical conditions (ie diabetes, kidney disease, heart disease, allergies, etc)*
Please indicate current medications, supplements, or special diets (name, dose and frequency).*
Thank you for taking the time to complete this form. 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*
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