New Client Registration Form

New Client Registration Form

Welcome to Sports Med Vet! Please fill out this form to register as a new client.
Owner Information
Full Name*

First NameLast Name
Email Address*
example@example.com
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityRegion

Postal CodeCountry
Horse Information
Horse's Name*
Breed
Age*
Gender*
Is your horse insured?

Yes
Referral Veterinarian (name and contact)*
By signing this form, you agree to Sports Med Vet contacting your regular veterinarian
Relevant Medical and Training History
Medical Records - please add any relevant files here

Cancelof
Reason for Appointment +/- Additional Comments (please enter any additional horses here)*
Preferred Appointment Type*

Ambulatory visit (we come to you)Telehealth phone consultation
Preferred Appointment Date

DayMonthYear
Date
Terms and Conditions*

I agree to pay a deposit of $300 when booking the first appointmentI understand and agree to the cancellation policy - 50% of deposit will not be refunded if cancellation or reschedule within 24 hours of appointment time (at vet discretion)I understand that Sports Med Vet is a specific and limited veterinary service (equine sports medicine and rehabilitation) and will not be available for emergency and out of hours veterinary care that is not directly related to this service. I agree to maintain a relationship with my General Veterinary Practitioner for routine and emergency veterinary care.
Signature*

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New Client Registration Form

Owner Information

Horse Information