The Little Vet Company - Registration Form

The Little Vet Company Registration Form
I'm new to The Little Vet CompanyI'm already a client, but with a new pet
Thanks for confirming you're already registered. To add a new pet, please call us on 01630 723150 or email admin@thelittlevets.co.uk. This form is only for new client registrations.
Please complete all sections on this form, we need the full details of all owners that would communicate with the practice regarding treatment and financial matters. A client account cannot be opened without a completed application form. Proof of identification and address will be required, for example a utility bill and photo identification. This information will not be stored on file. We will ask if your pet is insured, this does not affect the cost of treatment. We appreciate that this question can cause suspicion, however, it is for administration purposes only and facilitates direct claims.
- First Owner:
- Title:*
- Name*
  
  First NameLast Name
- Date of Birth (first owner)*
  
  DayMonthYear
  Date
- Address*
  
  House Name/Number
  
  Street Address Line 2
  
  CityCounty
  
  Post Code
- Email
  
  Confirmation EmailPlease confirm your email address.
- Primary Contact Number*
  Do NOT include country code (+44) - Max 11 digitsFormat: 00000000000.
- Alternative Contact Number
  Do NOT include country code (+44) - Max 11 digitsFormat: 00000000000.
- YesNo
- Second Owner
- Title:
- Name
  
  First NameLast Name
- Date of Birth (second owner)
  
  DayMonthYear
  Date
- Contact Number*
  Do NOT include country code (+44) - Max 11 digitsFormat: 00000000000.
- Alternative Number
  Do NOT include country code (+44) - Max 11 digitsFormat: 00000000000.
- Pet Details:
- Pet Name:*
- Pet Species:*
- Breed:
- MaleFemaleUnknown
- YesNoUnknown
- Date of Birth (Estimate if unsure):*
  
  DayMonthYear
  Date
- YesNo
- Insurance Company Name:
- Policy No:
- YesNo
- We note from your registration form that your dog has lived abroad. We would ask that your dog has a blood test for Brucella Canis. This is a blanket policy for any dog that has lived outside the UK. A copy of our policy can be found online: https://thelittlevets.co.uk/wp-content/uploads/2024/09/Brucella-Canis-Policy.docx If your dog has already had a Brucella test, please let us know. Otherwise, please call reception to book in for a blood test, or, if you would like to speak to someone regarding the information attached, please don’t hesitate to give us a call and speak to a vet. 01630 723150
- YesNo
- Pet Details 2:
- Pet Name:*
- Pet Species:*
- Breed:
- MaleFemaleUnknown
- YesNoUnknown
- Date of Birth (Estimate if unsure):*
  
  DayMonthYear
  Date
- YesNo
- Insurance Company Name:
- Policy No:
- YesNo
- We note from your registration form that your dog has lived abroad. We would ask that your dog has a blood test for Brucella Canis. This is a blanket policy for any dog that has lived outside the UK. A copy of our policy can be found online: https://thelittlevets.co.uk/wp-content/uploads/2024/09/Brucella-Canis-Policy.docx If your dog has already had a Brucella test, please let us know. Otherwise, please call reception to book in for a blood test, or, if you would like to speak to someone regarding the information attached, please don’t hesitate to give us a call and speak to a vet. 01630 723150723150
- YesNo
- Pet Details 3:
- Pet Name:*
- Pet Species:*
- Breed:
- MaleFemaleUnknown
- YesNoUnknown
- Date of Birth (Estimate if unsure):*
  
  DayMonthYear
  Date
- YesNo
- Insurance Company Name:
- Policy No:
- YesNo
- We note from your registration form that your dog has lived abroad. We would ask that your dog has a blood test for Brucella Canis. This is a blanket policy for any dog that has lived outside the UK. A copy of our policy can be found online: https://thelittlevets.co.uk/wp-content/uploads/2024/09/Brucella-Canis-Policy.docx If your dog has already had a Brucella test, please let us know. Otherwise, please call reception to book in for a blood test, or, if you would like to speak to someone regarding the information attached, please don’t hesitate to give us a call and speak to a vet. 01630 723150
- YesNo
- Pet Details 4:
- Pet Name:*
- Pet Species:*
- Breed:
- MaleFemaleUnknown
- YesNoUnknown
- Date of Birth (Estimate if unsure):*
  
  DayMonthYear
  Date
- YesNo
- Insurance Company Name:
- Policy No:
- YesNo
- We note from your registration form that your dog has lived abroad. We would ask that your dog has a blood test for Brucella Canis. This is a blanket policy for any dog that has lived outside the UK. A copy of our policy can be found online: https://thelittlevets.co.uk/wp-content/uploads/2024/09/Brucella-Canis-Policy.docx If your dog has already had a Brucella test, please let us know. Otherwise, please call reception to book in for a blood test, or, if you would like to speak to someone regarding the information attached, please don’t hesitate to give us a call and speak to a vet. 01630 723150
- YesNo
- Pet Details 5:
- Pet Name:*
- Pet Species:*
- Breed:
- MaleFemaleUnknown
- YesNoUnknown
- Date of Birth (Estimate if unsure):*
  
  DayMonthYear
  Date
- YesNo
- Insurance Company Name:
- Policy No:
- YesNo
- We note from your registration form that your dog has lived abroad. We would ask that your dog has a blood test for Brucella Canis. This is a blanket policy for any dog that has lived outside the UK. A copy of our policy can be found online: https://thelittlevets.co.uk/wp-content/uploads/2024/09/Brucella-Canis-Policy.docx If your dog has already had a Brucella test, please let us know. Otherwise, please call reception to book in for a blood test, or, if you would like to speak to someone regarding the information attached, please don’t hesitate to give us a call and speak to a vet. 01630 723150
- YesNo
- Pet Details 6:
- Pet Name:*
- Pet Species:*
- Breed:
- MaleFemaleUnknown
- YesNoUnknown
- Date of Birth (Estimate if unsure):*
  
  DayMonthYear
  Date
- YesNo
- Insurance Company Name:
- Policy No:
- YesNo
- We note from your registration form that your dog has lived abroad. We would ask that your dog has a blood test for Brucella Canis. This is a blanket policy for any dog that has lived outside the UK. A copy of our policy can be found online: https://thelittlevets.co.uk/wp-content/uploads/2024/09/Brucella-Canis-Policy.docx If your dog has already had a Brucella test, please let us know. Otherwise, please call reception to book in for a blood test, or, if you would like to speak to someone regarding the information attached, please don’t hesitate to give us a call and speak to a vet. 01630 723150
- YesNo
- Pet Details 7:
- Pet Name:*
- Pet Species:*
- Breed:
- MaleFemaleUnknown
- YesNoUnknown
- Date of Birth (Estimate if unsure):*
  
  DayMonthYear
  Date
- YesNo
- Insurance Company Name:
- Policy No:
- YesNo
- We note from your registration form that your dog has lived abroad. We would ask that your dog has a blood test for Brucella Canis. This is a blanket policy for any dog that has lived outside the UK. A copy of our policy can be found online: https://thelittlevets.co.uk/wp-content/uploads/2024/09/Brucella-Canis-Policy.docx If your dog has already had a Brucella test, please let us know. Otherwise, please call reception to book in for a blood test, or, if you would like to speak to someone regarding the information attached, please don’t hesitate to give us a call and speak to a vet. 01630 723150
- YesNo
- Pet Details 8:
- Pet Name:*
- Pet Species:*
- Breed:
- MaleFemaleUnknown
- YesNoUnknown
- Date of Birth (Estimate if unsure):*
  
  DayMonthYear
  Date
- YesNo
- Insurance Company Name:
- Policy No:
- YesNo
- We note from your registration form that your dog has lived abroad. We would ask that your dog has a blood test for Brucella Canis. This is a blanket policy for any dog that has lived outside the UK. A copy of our policy can be found online: https://thelittlevets.co.uk/wp-content/uploads/2024/09/Brucella-Canis-Policy.docx If your dog has already had a Brucella test, please let us know. Otherwise, please call reception to book in for a blood test, or, if you would like to speak to someone regarding the information attached, please don’t hesitate to give us a call and speak to a vet. 01630 723150
- YesNo
- Pet Details 9:
- Pet Name:*
- Pet Species:*
- Breed:
- MaleFemaleUnknown
- YesNoUnknown
- Date of Birth (Estimate if unsure):*
  
  DayMonthYear
  Date
- YesNo
- Insurance Company Name:
- Policy No:
- YesNo
- We note from your registration form that your dog has lived abroad. We would ask that your dog has a blood test for Brucella Canis. This is a blanket policy for any dog that has lived outside the UK. A copy of our policy can be found online: https://thelittlevets.co.uk/wp-content/uploads/2024/09/Brucella-Canis-Policy.docx If your dog has already had a Brucella test, please let us know. Otherwise, please call reception to book in for a blood test, or, if you would like to speak to someone regarding the information attached, please don’t hesitate to give us a call and speak to a vet. 01630 723150
- YesNo
- Pet Details 10:
- Pet Name:*
- Pet Species:*
- Breed:
- MaleFemaleUnknown
- YesNoUnknown
- Date of Birth (Estimate if unsure):*
  
  DayMonthYear
  Date
- YesNo
- Insurance Company Name:
- Policy No:
- YesNo
- We note from your registration form that your dog has lived abroad. We would ask that your dog has a blood test for Brucella Canis. This is a blanket policy for any dog that has lived outside the UK. A copy of our policy can be found online: https://thelittlevets.co.uk/wp-content/uploads/2024/09/Brucella-Canis-Policy.docx If your dog has already had a Brucella test, please let us know. Otherwise, please call reception to book in for a blood test, or, if you would like to speak to someone regarding the information attached, please don’t hesitate to give us a call and speak to a vet. 01630 723150
- Please contact your previous vet and ask for your pet’s history to be sent to admin@thelittlevets.co.uk
- Invoices and Statements (Contractual) We may contact you by the any of following methods: Post/Email/Phone/Text
- MARKETING POLICY
  
  As your veterinary team, we may contact you via post, email, phone, or text to keep you informed and provide the best care for your pets. If you would prefer not to be contacted through any of these methods, please get in touch with us directly to opt out.
- By ticking the box below I am confirming the following: That I have read and agree to the Terms and Conditions of The Little Vet Company. (Available on our website; www.thelittlevets.co.uk from the 9th of September 2024). That I have read and agree to the Payment Policy of The Little Vet Company (Available at the practice and on our website; www.thelittlevets.co.uk). That I have read and completed the Marketing Policy of The Little Vet Company.*
  
  I agree
- Should be Empty:

The Little Vet Company Registration Form

First Owner:

Second Owner

Pet Details:

Pet Details 2:

Pet Details 3:

Pet Details 4:

Pet Details 5:

Pet Details 6:

Pet Details 7:

Pet Details 8:

Pet Details 9:

Pet Details 10: