FVC - New Client Form

Appointment Information
Thank you for giving us the opportunity to care for your pet. To help us provide the best possible care today and in the future, please take a moment to share some important information with us.

We understand that plans can sometimes change. If you do need to adjust or cancel your appointment, we would greatly appreciate it if you could let us know more than 24 hours in advance so we can offer that time to another pet in need.
Do you already have an appointment booked with us?*

YesNo
If no, what day and time would like to request?

MonthDayYearHourMinutesAM/PM Option
Please be aware that this is an appointment request only. Our team at Fernwood Veterinary Clinic will be in touch soon to officially confirm your booking.
Owner's Information
Full Name*

First NameMiddle NameLast Name
Preferred Pronouns
Primary Phone Number*

Area CodePhone Number
Alt. Phone Number

Area CodePhone Number
E-mail*
Address*

Street Address

Apt, Suite, Bldg. (Optional)

CityState / Province

Postal / Zip CodeCountry
Spouse's Information
Spouse's Name

First NameMiddle NameLast Name
Preferred Pronouns
Spouse's Phone Number

Area CodePhone Number
Spouse's E-mail
May we send you reminders, notices, and information by email?
How would you prefer we communicate your upcoming reminders?
Pet's Information
Please fill out all of the following information about your pet.
Pet's Name*
(The star of the show!)
Species*
Breed*
Color*
Birth Date*

MonthDayYear
(If you aren't sure, an approximate date or year is perfectly fine.)
Birth Date*

MonthDayYear
Sex*

FemaleMale
Fixed*

YesNoUnsure
Last Vaccination(s)
Current Medications
Previous Clinic
Medical Issues (if any)
Do you have pet insurance?*

YesNo
If yes, which company?
Enter your policy number (if applicable):
Microchip / Tattoo Number:
Has your pet traveled outside of Vancouver Island?*

YesNo
If yes, where did they go and around what dates?
Do you have any other pets?

YesNo
If yes, what are their name(s) and species?
We occasionally feature our patients on our social media accounts. Do you consent to us sharing photos of your pet online?*

Yes, you can share.No, I prefer not.
How did you hear about us?
Please specify.
Should be Empty:

Appointment Information

Owner's Information

Spouse's Information

Pet's Information