Client Registration
Claro Hill Vets
Date
-
Month
-
Day
Year
Date
Client/Account Information
Contact person 1
Mr
Mrs
Ms
Miss
Dr
Rev
Prefix
First Name
Last Name
Mobile number
E-mail address
example@example.com
Contact person 2
Mr
Mrs
Ms
Miss
Dr
Rev
Prefix
First Name
Last Name
Mobile number
E-mail address
example@example.com
Address
Street Address
Street Address Line 2
City
County
Postcode
Home phone
Work phone
Information about your pets
Pet 1
Species
Dog
Cat
Rabbit/small mammal
Breed
DOB or approximate age
Sex
Female entire
Female neutered
Male entire
Male neutered
Pet 2
Species
Dog
Cat
Rabbit/small mammal
Breed
DOB or approximate age
Sex
Female entire
Female neutered
Male entire
Male neutered
Additional Information
Name of current vets
Are you happy for Claro Hill Vets to contact your current vets and request all clinical history and results?
Yes
No
Would you be happy to receive information on offers, promotions and marketing via email?
Yes
No
Specific registration requests/details. Please include details of any additional pets.
How did you hear about us?
Word of mouth
Facebook
Instagram
Local resident / spotted our banner
Article in the press
Leaflet through your door
Search engine
Other
Submit
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