New Client Intake Form

Please note current wait times for non-urgent appointments are approximately 2 weeks. For urgent appointments we will try our best to accommodate but this is not always possible, please phone to discuss. Pre-payment for your first exam is required. One of our client care team will contact you within 72 business hours. Please phone if you have not heard from us in that timeframe. (250) 585-0911.

Primary Contact

First Name

Last Name

Secondary Contact

First Name

Last Name

Primary Email

Secondary Email

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Primary Phone Number

(###)

###

####

Secondary Phone Number

(###)

###

####

Pet's Name

Species

Pet's date of birth

Please provide an estimate if unknown

YYYY

Pet's colour

Pet's sex

Breed

Insurance

Current Medications

Current Diet

Microchip or Tattoo

Current medical conditions

Reason for appointment