Equine Client Details
In order to finalise your appointment, please complete the registration process by providing your contact and animal details
Owner Details
*
Ms.
Mrs.
Mr.
Dr
Prof.
Prefix
First Name
Last Name
Address
*
Address Line 1
Address Line 2
County
Eircode
Owners Email
*
example@example.com
Telephone Number
*
Mobile Number
*
Additional Contact Details
In the event of an emergency or we are unable to contact you, please provide details of someone who you have given the authority to provide consent for additional treatment or costs.
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Relationaship to Animal Owner
Please confirm the name of your Primary Vet
First Name
Last Name
Practice Name
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Patient Details
Animal's Name
*
Breed
Colour
Date of Birth
*
-
Day
-
Month
Year
Date
Gender
*
Male
Female
Microchip Number
Passport Number
Date of last vaccine
-
Day
-
Month
Year
Date
Is the patient insured?
Yes
No
If yes, please provide policy details below
Allianz
petsinsure.ie
petinsurance.ie
An Post
Other
Insurance Policy Number
File Upload - images of Passport Marking Sheet, vaccine page & any previous medical history
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
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Next
Stable Details
Stable Name
Stable Premises Number
Address
Street Address
Street Address Line 2
Town
County
Eircode
Stable Phone Number
Please enter a valid phone number.
In your absence, please provide the name of the yard person who is authorised to consent to treatment and charges on your behalf
First Name
Last Name
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Appointment Details
Please enter the appointment details sent to you by text message
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Can you attend UCD Veterinary Hospital at the appointed time/date as per the text message? (If No, we will contact you to discuss an alternative appointment date / time)
Yes
No
Please verify that you are human
*
Submit
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