New Client Enrolment form

Villlage of Manotick Animal Hospital

Nepean-Rideau Veterinary Professional Corporation

5547 Scharfield Rd

Mantotick, ON K4M 1A9

(613) 692-2434

We are proudly able to accept new clients and patients at this time. Please complete and submit this form and our reception staff will be in touch about booking an appointment. Thank you for your interest in joining the Village of Manotick Animal Hospital family.

Client 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

Do you have a preferred veterinarian at our clinic?

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

Reason for transfer*

New puppy or kittenNew to areaOther

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)?*

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 Village of Manotick Animal Hospital family.

Please verify that you are human*