New Client Information Form

New Client Information Form

Thank you for inquiring about becoming a client at our clinic! Please fill in the form below and hit submit. We will get back to you in 1-2 business days. The VVC Team
Primary Contact

First NameLast Name
Secondary Contact Name

First NameLast Name
Primary Contact Number
Please enter a valid phone number.Format: (000) 000-0000.
Secondary Contact Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
We can only have one on file
Address

Street Address

Street Address Line 2

CityProvince

Postal Code
Pet # 1
Please give us the following: Name, species, breed, colour, sex, (spayed or neutered), date of birth/age
Pet # 2
Please give us the following: Name, species, breed, colour, sex, (spayed or neutered), date of birth/age
Your previous veterinary clinic
N/A if not applicable
Reason for changing
N/A if not applicable
Please note the two most important previous medical conditions your pet might have. Our appointments are scheduled for 1/2 hour and it is possible that all issues might not be taken care of in your initial appointment.
Does your pet experience anxiety at the vet?
Do you have Insurance for your pet? If so, which company and the policy number.
If you would like to schedule an appointment, please provide us with a date and time and also let us know which pet it is for and what type of appointment you are requesting. We will let you know if we have availability once we set up your file. THIS IS NOT YOUR ACTUAL APPOINTMENT. (optional)
Main Contact

First NameLast Name
Should be Empty: