CLIENT REGISTRATION FORM

CLIENT REGISTRATION FORM
CLIENT DETAILS
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

TownState / Province

Post Code
Visit Address

If different from above

Street Address Line 2

CityState / Province

Postal / Zip Code
Visit Type Required*

Home VisitsYard visitsFarm VisitsOther
Telephone Number *
Alternative Contact Number (optional)
Please enter a valid phone number.Format: 00000000000.
Email
example@example.com

ANIMAL DETAILS

Please provide details of any pets you would like to register.
Which animals would you like to register?*

DogsCatsRabbits / Guinea PigsHorsesSheepDairy CattleBeef CattleOther

ANIMAL DETAILS

Please provide details of any pets you would like to register.
Please give details of the livestock you would like to register

Including approximate stock numbers, type and breed where possible0/100
Would you like to register any other animals?

YesNo

PRACTICE DETAILS
KVS offers tailored mobile veterinary care to animals of all shapes and sizes in the comfort of their own home or yard.

As of 2025, we are also proud to be able to offer hospitalisation, advanced diagnostics and surgical treatment in our state of the art clinic trailer for patients who require more intensive and continued care.

Whilst we are constantly evolving & expanding our services and equipment, we are currently not able to offer x-ray imaging in our clinic. To ensure that our patients have access to comprehensive care, including advanced imaging techniques, we recommend that clients consider mutual registration with a veterinary practice who can provide this facility.

We aim to work alongside all local practices and should we find anything that requires investigation outwith our services, we are happy to recommend and facilitate treatment at another practice(s) or arrange referral to a veterinary hospital.
What is the name of your current veterinary practice?*
What is the name of your current veterinary practice?
Current Veterinary Practice
Would you like to register with KVS as your sole first opinion veterinary care provider or alongside your current practice?

KVS will be my ONLY First opinion Veterinary PracticeKVS will be my MAIN First opinion Veterinary PracticeAnother practice will be my main veterinary care providerI'd prefer not to say

CONSENT
I consent to Kintyre Veterinary Services sharing any clinically relevant information with any other veterinary practices treating my animals in the interests of my pets' health and wellbeing. This may include my personal data and animals’ medical records.*

YesNo (Please note that without this consent we are unfortunately unable to register your animals under our care)
Your current/previous Vet practice also requires consent to share information with us. Please contact your current vet at your earliest convenience to give consent for your animals' histories to be shared if necessary.*

Yes, I confirm I will request my animal(s) relevant medical records are shared with KVSNo (Please note that without this consent we are unfortunately unable to register your animals under our care)
Westwards Veterinary Practice have asked that any mutual clients email Campbeltownvets@outlook.com to confirm your consent to share data

This email can simply state:

'I, [your name] of [your address] confirm that I consent to Westwards Veterinary Practice sharing my animals' records with Kintyre Veterinary Services'
As a predominantly mobile veterinary service, we do not currently provide advanced surgical or X-ray services. We therefore recommend that clients are also registered with a local Veterinary Practice who can provide these services

I understand

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CLIENT DETAILS