New Client Registration – 2 owners & 3 pets If you are human, leave this field blank.Client InformationThis form is to provide information prior to appointment that you have already scheduled with us at Hazeldean Animal Hospital. If you have yet to make an appointment please contact us at (613)-831-8788. Full Name *Primary OwnerFull Name *Address Line 1 *Address Line 2City *Province *ONQCBCABMBSKNSNBNLPENTYTNUPostal Code *Home Phone *Work PhoneCell PhonePrimary Phone *Home PhoneWork PhoneCell PhoneEmail *1st Pet InformationName *Date of BirthAgeSpecies *DogCatOtherBreedColourSexMaleFemaleIs your pet spayed or neutered?YesNoCurrent MedicationsCurrent Medical ConditionsPrevious IllnessesPrevious SurgeriesDietAllergiesSpecial ConcernsPrevious Veterinarian or Clinic #1Previous Veterinarian or Clinic #22nd Pet InformationName *Date of BirthAgeSpecies *CatDogOtherBreedColourSexMaleFemaleIs your pet spayed or neutered?YesNoCurrent MedicationsCurrent Medical ConditionsPrevious IllnessesPrevious SurgeriesDietAllergiesSpecial ConcernsPrevious Veterinary or Clinic #1Previous Veterinary or Clinic #23rd Pet InformationName *Date of BirthAgeSpecies *CatDogOtherBreedColourSexMaleFemaleIs your pet spayed or neutered?YesNoCurrent MedicationsCurrent Medical ConditionsPrevious IllnessesPrevious SurgeriesDietAllergiesSpecial ConcernsPrevious Veterinarian or Clinic #1Previous Veterinarian or Clinic #2Getting to know youWhen is your appointment? *I/We recognize that verbal and physical abuse towards staff or other patrons at Hazeldean Animal Hospital will not be tolerated. Such behaviour will result in immediate request to leave the premises and termination of future services.I agree *I/We recognize that if any pet has not been seen by Hazeldean Animal Hospital in the last 5 years then the veterinary patient client bond is not established and this pet is no longer considered a patient. Files that have been inactive for this period of time will be inactivated.I agreeBy submitting this form you acknowledge that this information is correct and will solely be used by Hazeldean Animal Hospital.We look forward to seeing you at your appointment. If you have any questions at any time please don’t hesitate to call us at (613)-831-8788. The Animal Health Team at Hazeldean Animal HospitalSubmit Share this:EmailPrintFacebookLinkedInTwitter