Tiny Vet Clinic (TVC) Registration
This form is for financially disadvantaged clients who hold a Healthcare Card. If your pet needs urgent care, please visit your local veterinarian, rather than waiting for the next Tiny Vet Clinic (any vet can apply for assistance on your behalf). The TVC does not perform procedures or surgeries like desexing or lump removals. We encourage pet owners to contribute towards the cost of their pet's care by paying for our low-priced medications, however consultations will be free of charge.
Name
*
First Name
Last Name
Which clinic would you like to attend?
*
Karabar 1st Wednesday of the month (please note there will be no clinic on New Years Day)
Ainslie Village 2nd Wednesday of the month (opposite CWC auto services)
Kambah 4th Wednesday of the month (please note there will be no clinic on Christmas Day)
Do you have a Healthcare Card?
*
Yes
No
Not sure
Please provide the last 4 digits of your Healthcare Card and the expiry date
*
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 (please include species under 'breed' below)
Breed
*
Sex
*
Male
Female
Desexed?
*
Yes
No
Unknown
Age or Date of Birth of Pet
*
Microchip number, type unknown if you don't know this information
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 for your pet? Please note that we sometimes need to prioritise urgent versus non-urgent care as our volunteer resources are limited.
*
Has your veterinarian referred you to the Tiny Vet Clinic to have a specific condition rechecked or managed? If so, please tick 'yes' so we can request the vet history.
*
Yes
No
Not sure
Name of previous vet clinic
*
How did you hear about the Tiny Vet Clinic?
*
Social media helps us to promote and fundraise for the TVC. Do you consent to photos of your pet appearing on social media?
*
Yes but pet only (no photos of me)
No (no photos at all)
Happy for photos of me and my pet to appear on social media
Please tick the box below to confirm that you will ensure your cat is in a carrier and your dog is on a lead at all times.
*
Yes I understand
Please tick the box below to confirm that you understand that we run on a triage system. This means that if you are attending for vaccination, more urgent cases will be seen first. If we are busy, your pet's vaccination may need to be postponed until the next clinic with two volunteer vets available.
*
Yes I understand
Our Privacy Policy is available on our website at actpetcrisis.com and I understand I can view it online for further information.
Yes I understand
Submit
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