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New Client Registration Form
Owner's Name *
Primary Phone Number *
Secondary Phone Number
Owner's Email *
Spouse/Co-Owner Name *
Co-Owner Phone Number
Owner's Mailing Address *
City *
Province *
Postal Code *
*** Owner's listed above cannot be removed without consent from both parties ***
What is your preferred method of communication for medical & appointment reminders? Choose all that apply (Only the primary owner will receive reminders) *
Email
Mail
Text Message
We occasionally share pet photos on social media, featuring only their name and image. Do we have your permission to take and use photos of your pet? *
Yes - Okay to post photos
No - Please do not use my pet's photo
How were you referred to our practice? *
Please Select
Existing Client
Family/Friend
Close to Home
Facebook
SPCA/CHS
Google
Other Veterinary Clinic
Drove By/Saw Clinic Sign
Other
List other individuals who may authorize treatment of your pet(s):
I agree to be held financially responsible for all pets in this file and to pay all fees, including services authorized by the individuals listed above. All fees are due at the time services are rendered. I understand that any medical or surgical procedure carries some risk and that it is not possible to guarantee a successful outcome of any procedure. This agreement will remain in effect indefinitely from this date, unless I notify Britannia Kingsland Veterinary Clinic in writing, requesting to cancel the agreement *
I agree to receiving marketing and promotional materials
Yes
No, thank you
Security Question *
I HAVE READ AND UNDERSTOOD THE
PRIVACY POLICY
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Rabbit Services
New Pet Owner Information
Online Store
Careers
Resources
Blog
How-To Videos
Useful Links
Pet Loss Info & Support
Travelling With Your Pet
Pet Ownership Handbooks
Forms
New Client Registration
New Patient (Canine/Feline)
New Patient (Rabbit)
New Patient (Pocket Pet)
New Patient (Reptile)
New Patient (Ferret)
New Patient (Bird)
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