New Client Application - Hazeldean Animal Hospital

Due to high demand and with celebration of finally being fully staffed and trained, for a limited time we will be opening up to some new clients. We have been accepting new puppies and kittens needing care for the last few months and think we are ready to help some adult pets as well. We want to make the process fair and we also want to make sure we are not compromising our ability to provide excellent care to our current and future patients. We are one of the very few privately owned veterinary clinics in the area and we strive to provide excellent care and form long lasting relationships with both the patient and their families.

If you know of someone who would like to join our clinic, then please let them know that we may be accepting new clients. This will be for a limited time, but from time to time as schedule allows we may open new spots. Please visit our website at www.hazeldeananimalhospital.ca and fill out the NEW CLIENT APPLICATION FORM.

Alert – You have entered the NEW CLIENT APPLICATION if you already have an appointment booked at Hazeldean Animal Hospital please go to the NEW CLIENT REGISTRATION document to prepare for your appointment. If you don’t have an appointment please be aware that this is an application that will be reviewed as positions become available and is not a guaranteed admittance to Hazeldean Animal Hospital as a client or patient.

We would like to know the following:

Full Name: *

Address: *

Country

City

State

Zip code

Best Phone Number: *

Best Email Address: *

Do you currently have veterinary care locally? *

Yes

If so, why are you wanting to make a change?

What are your feelings on preventive health care?

Who is your current or previous veterinary clinic?

Patient 1 Information (Required)

Patient 1 Name: *

Species: *

Breed:

Age:

Is your pet spayed or neutered?

Yes

Does your pet have any current health conditions that require management?

Is your pet currently on any medications, supplements or preventatives? If so, what?

When was your pet last at the veterinarian?

When is your pet due for their next regular check up?

What is your pet currently eating?

Patient 2 Information (Optional)

Patient 2 Name:

Species:

Breed:

Age:

Is your pet spayed or neutered?

Yes

Does your pet have any current health conditions that require management?

Is your pet currently on any medications, supplements or preventatives? If so, what?

When was your pet last at the veterinarian?

When is your pet due for their next regular check up?

What is your pet currently eating?

Patient 3 Information (Optional)

Patient 3 Name:

Species:

Breed:

Age:

Is your pet spayed or neutered?

Yes

Does your pet have any current health conditions that require management?

Is your pet currently on any medications, supplements or preventatives? If so, what?

When was your pet last at the veterinarian?

When is your pet due for their next regular check up?

What is your pet currently eating?

I give permission for Hazeldean Animal Hospital to contact my previous veterinary hospital to obtain information on my pets’ medical history and care. *We will not transfer your file from another veterinary facility without further permissions obtained.

Yes

Patient 1 Information (Required)

Patient 2 Information (Optional)

Patient 3 Information (Optional)

Share this: