Kelly Vets Registration Form

What is your name?*

TitleFirst NameLast Name

What would you like us to call you?*

(For example, "Sarah" or "Mr. Jones")

What are your preferred pronouns?*

Phone Number*

Please enter a valid phone number.

Email Address*

This email will be used for essential communications, such as appointment confirmation/reminders, invoices, and reminders for your pet's medical treatments (vaccinations, medications, etc).

Would you like to sign up to our email list for non-essential communications? This will include very occasional marketing and practice updates.*

YesNo

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Are there any special access, parking, or security instructions at your home?*

e.g. permit parking only, gate access code, visitor pass required

Is anyone in your household immunocompromised?*

Is there anyone you would like to give us permission to speak to or make decisions about your pets' health? Please list their names and relationships below. *

Is there anything we can do to make our visits more comfortable for you?*

For example: I'm sensitive to perfumes, please leave written instructions, direct eye contact makes me uncomfortable

Pet's Name*

Official NameAny nicknames?

Please read and confirm all of the following statements*

I confirm that I am the pet's legal owner and have the right to make medical decisions for them.I understand that additional procedures or daytime emergency appointments that are unsuitable for home visits will be offered by West Edinburgh Vets. If I wish to use another vet, it is my responsibility to make these arrangements separately. (Exotic pets may be seen by either West Edinburgh or Fife Exotic Vets.)

Species*

Breed*

Colour*

Sex*

Has your pet been neutered?*

Has your pet been microchipped?*

Date of Birth*

DayMonthYear

Last known weight*

Please list all of the previous vets your pet has seen.*

We will need to request their medical records to accept them into our care.

Does your pet get along with other animals and people?*

Please provide additional information as needed.

Does your pet experience fear or anxiety during traditional veterinary visits?*

Please provide as much information as possible about what makes them anxious.

Do you have any concerns about handling or restraining your pet during our visit?*

Please specify if your pet has previously required a muzzle during traditional veterinary visits. *Note: while our goal is to work towards eliminating the need for muzzles, our top priority is to keep everyone safe.

Has your pet ever been prescribed medication to be taken prior to a vet visit for fear, anxiety, or aggression? If so, please specify the medication used and the outcome.*

For example,"gabapentin worked well for a blood test" or "we tried trazodone but it gave my pet diarrhoea"

Is there anything that can be done to make your pet feel more comfortable during the visit?*

For example: "he hates needles", "she doesn't like her paws touched", "he will do anything for lik-e-lix". Please provide as much detail as possible.

We would love for you to upload a photo of your pet for their file.

Do we have your permission to use photos of your pet on our website or social media?*

How did you hear about us?

Client Information

Pet Information