Westshore Pet Clinic New Client Intake Form

  • New Client Intake Form

    Thank you for choosing Westshore Pet Clinic to care for your beloved four legged friend! Please fill out this Intake and Release Form prior to your first visit.

  • IMPORTANT:

    Please wait until you receive an email titled "Welcome to Westshore Pet Clinic" before calling to schedule an appointment!
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  • Please select phone type for PRIMARY contact number:
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  • Please select phone type for SECONDARY contact number:
  • How Would You Prefer To Be Contacted?*
  • Is There a Partner/Family Member Who You Would Like To Be Listed On Your Account?*
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  • Please select phone type for partner/family contact number:

  • In case of emergency...

  • Is there anyone else (besides above listed contacts) who should be listed on your account, who has ongoing permission to make medical decisions for your pet(s)?*
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  • How did you hear about us?

  • Pet Information

    All the details on your furry friends!
  • Browse Files
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  • Species*
  • Pets age*
  • Date of Birth
     - -
  • Sex*
  • Is Your Pet Microchipped?*
  • In case of any emergencies while your pet is in our care in the clinic, would you like us to perform basic CPR?*
  • Do You Already Have a Scheduled Appointment?*
  • Appointment Date
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  • Do You Have More Than One Pet At Home?
  • Browse Files
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  • Species*
  • Pets age*
  • Date of Birth
     - -
  • Sex*
  • Is Your Pet Microchipped?*
  • In case of any emergencies while your pet is in our care in the clinic, would you like us to perform basic CPR?*
  • Do you have more than 2 pets at home?
  • Browse Files
    Cancelof
  • Species*
  • Pets age*
  • Date of Birth
     - -
  • Sex*
  • Is Your Pet Microchipped?*
  • In case of any emergencies while your pet is in our care in the clinic, would you like us to perform basic CPR?*
  • Do You Have More than 3 Pets At Home?
  • Browse Files
    Cancelof
  • Species*
  • Pets age*
  • Date of Birth
     - -
  • Sex*
  • Is Your Pet Microchipped?*
  • In case of any emergencies while your pet is in our care in the clinic, would you like us to perform basic CPR?*
  • Has your pet(s) been seen at another veterinary clinic?*
  • Please reach out to Westshore Pet Clinic if you have more than 4 pets in your household and we will be happy to collect the information on your other pets to add them to your file.

  • Client Policies and Procedures

    Please read through to be aware of and understand the following policies and procedures for all of our clients.
  • We Love connecting by Social Media! Do we have your permission to post pictures we take of your pet(s), you and your pet(s) and/or your pet(s) and our team on our Facebook, Instagram, TikTok, www.westshorevet.ca and any other marketing and/or other social media outlets we may choose to use? We will only use photos taken by a staff member of Westshore Pet Clinic while your pet is in our care.*

  • PHOTO RELEASE CONSENT: By signing this document, I confirm that I am over 18 years old. I have read, understood and agree to the terms and conditions of this agreement and that it is my intention to enter into an agreement to waive my rights, including my right to sue, with respect to the use of the recordings and my image as captured in the recordings. I agree to release Westshore Pet Clinic from all claims for libel, slander, invasion of privacy, infringement and copyright or right of publicity or any other claim.

  • Would you like to receive our newsletter to your email? Westshore Pet Clinic will only send out one newsletter every few months, and will not use your email for any other purpose without your consent.*

  • TREATMENT CONSENT: By signing this document, I declare I am the lawful owner of all listed pets and all information is true and correct to the best of my knowledge. I hereby authorize the veterinarian(s) of Westshore Pet Clinic to examine, prescribe for or treat my pet(s) to the best of their abilities. I assume responsibility for all charges incurred in the care of this animal. I acknowledge that medical information will not be released to anyone not indicated on this form without my verbal and/or written consent, with the exception of another veterinary facility.

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