New Client Form

Please fill out this form in order to be added to our new client waitlist. We will contact you when we are able to accommodate an appointment for your pet.

If your pet has an urgent medical need, please contact us for guidance at 250-248-0008 or call Central Island Veterinary Emergency Hospital at 250-933-0913.

Location

{$ IvcPractices.Form.Label.SecurityQuestion }

Your Name *

Secondary Owner Name

Primary Phone Number *

Secondary Phone Number

Address *

City *

Province *

Postal Code *

Email *

PREVIOUS VETERINARY CLINIC

May we contact your previous veterinary clinic for your pet's health records? *

Yes
No

Name and location of previous clinic

PET INFORMATION

Pet's Name *

Is your pet a: *

Dog
Cat
Pocket Pet

What breed is your pet? *

What is your pet's date of birth?

Is your pet a: *

Is your pet spayed or neutered? *

Yes
No

How does your pet usually behave at the vet? Is there anything in particular he or she doesn't like? *

Sometimes we take photos of our patients. Do you consent to use of photos of your pet on our social media sites? *

Yes
No

Security Question *

I HAVE READ AND UNDERSTOOD THE PRIVACY POLICY *

New Client Form

OWNER INFORMATION

PREVIOUS VETERINARY CLINIC

PET INFORMATION

Our Cookies

About Cookies

Cookie settings

Functional cookies

Analytics cookies

Marketing cookies