PET OWNER'S INFORMATION
First and last name (required)
Spouse first and last name (optional)
Email (required)
Primary phone (required)
Type: —Please choose an option— Mobile Landline
If you provide a mobile number, we will send you a text when we're on our way to your home. Please consider providing any additional phone numbers that we can use to contact you if necessary, such as a spouse's phone, a work phone, or a home landline. You can provide up to three additional numbers below.
Would you like to add a second phone?
Yes No
Whose phone is this?
Additional phone
Type: —Please choose an option— Mobile Landline
Would you like to add a third phone?
Yes No
Whose phone is this?
Additional phone
Type: —Please choose an option— Mobile Landline
Would you like to add a fourth phone?
Yes No
Whose phone is this?
Additional phone
Type: —Please choose an option— Mobile Landline
House Address
House/unit number and street (required)
City (required)
Postal code (required)
Would you like to add a separate mailing address?
Yes No Names of other people in the household (children, housemates, etc.) (required)
Previous vet clinic (required)
Do we have permission to request records from your previous vet clinic?
Yes No Have you already booked an appointment time?
Yes No PET INFORMATION
Please provide information about all of the pets in your household that you may want us to see at some point. You can provide information about up to five pets below. If you have more than five, please make the appropriate selection below after providing information about your first five pets. We will reach out by email to collect the necessary information about your additional pets.
First pet:
Name of pet (required)
Type of pet (required)
Dog Cat Other If other, please explain (optional)
Sex of pet (required)
Male Female Breed of pet (required)
Color of pet (required)
Age of pet (optional)
Pet's birthday (required)
Is your pet spayed or neutered? (required)
Yes No Does this pet have health insurance? (required)
Yes No If yes, what is the name of the insurance company? (optional)
Is there anything else that we should know about this pet? (optional)
Would you like to add a second pet?
Yes No Would you like to add a third pet?
Yes No Would you like to add a fourth pet?
Yes No Would you like to add a fifth pet?
Yes No Do you have more pets to add?
Yes No
Other pets:
Thank you, your response has been noted! We'll reach out to collect the additional pet information from you shortly. Please proceed with the new client form when you're ready.
OTHER INFORMATION
How did you hear about us? (optional)
Friend or family Referral Facebook Instagram Internet search Website Other
Who can we thank for the recommendation/referral? (optional)
Are you willing to share the name of the website? (optional)
For other, are you willing to explain? (optional)
Is there anything else you'd like us to know? (optional)
CANCELLATION POLICY
If you find you need to reschedule your appointment, we require notice at least two business days in advance. Appointments are in high demand, and your advanced notice will allow another patient access to that appointment time. Additionally, as a mobile service we need to plan our travel to our appointments in a very specific way. Your assistance will help keep our service running as smoothly as possible.
If you are unable to provide sufficient notice for cancelling or rescheduling your appointment, you may be subject to a $183 cancellation fee.
I understand and consent to the cancellation policy. PAYMENT POLICY
Please note that payment is due at the time of your appointment. We are able to accept e-transfer, Visa, Mastercard, Debit, and cash.
We understand that costs associated with pet care can be stressful. If you have financial limitations, we ask that you bring those to our attention at the time of booking. We strive to provide our patients with the best possible care, while also respecting each client's personal budget.
I understand and consent to the payment policy. Thanks! We're all done. Go ahead and click the "Submit" button below when you're ready.
Please note: We typically reply to all communications within 24 hours during the week. If you haven't heard from us within that time, please check your junk mail folder.
