Campbell River VH - New Client Waitlist

New Client Registration - Waitlist

Thank you for considering our hospital as your pet’s provider of veterinary services. We are dedicated to maintaining the health of your pet and look forward to many future years together.

Please complete this form to be placed on our waiting list. (Please note that this does not mean that you will definitely get an appointment, or that you are considered an active client at our hospital, but we are trying our best to provide care to as many pets as we can.)

Our team will reach out to you as appointments become available. The required sections have a red * asterisk.

Your Name*

First NameLast Name

Phone Number*

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityProvince

Postal Code

PET INFORMATION*

	Pet Name	Age	Species	Breed	Colour	Spayed/Neutered
1.
2.
3.
4.
5.

Name of previous veterinary hospital so we may obtain your pet's medical records:*

How long have you lived in the Campbell River area?*

What veterinary service(s) do you require? (i.e. vaccines, spay/neuter, dental, medical, etc.)*

Additional Comments:

I understand that filling out this form DOES NOT guarantee that I will get an appointment. Our team will reach out to you when we are able to take you on as a client.*

Yes

CAPTCHA*