New Client Form Tiny Vet Clinic
This form is for financially disadvantaged clients who need assistance with veterinary care via the Tiny Vet Clinic. The clinic is subject to availability of volunteers and resources. The clinic will not be performing procedures or surgeries. We encourage pet owners to contribute towards the cost of their pet's care by paying for our low-priced medications, vaccinations and other treatments, however consultations will be free of charge.
Name
First Name
Last Name
Vet clinic you have previously attended
Are you happy for us to request a vet history?
Yes
No
Do you have a Healthcare Card and/or are you on a Centrelink payment?
Yes
No
Not sure
Have you applied for VetPay?
Yes
No
Not sure
Email address
example@example.com
Phone Number
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
Suburb
State / Province
Postal / Zip Code
Pet's Name
Species
Cat
Dog
Other
Breed
Sex
Male
Female
Desexed?
Yes
No
Unknown
Age or Date of Birth of Pet
Does your pet have a history of any health problems (eg allergies, arthritis, previous surgeries)? If so provide details.
What would you like the Tiny Vet Clinic to do (eg vaccination, microchipping, treat ear infection)?
Name of vet clinic your pet has been to in the past
Are you happy for us to request a history from your vet?
Yes
No
Not sure
How did you hear about the Tiny Vet Clinic?
Submit
Should be Empty: