New Client Registration

Owner's Name:

Co-Owner/Spouse/Relative's Name:

Address:

City:

Postal Code:

Home Phone:

Cell Phone:

Co-owner phone

Email:

Previous Veterinary Hospital

Does your pet have any known allergies?

Do you have pet insurance?

Insurance Company

Policy/ Customer #

#1 Pet's Name

Species

Breed

Colour

Sex

Female Male

Spay OR Neuter

Yes No

Date Of Birth

Vaccines up to date?

Yes No

General health ?

#2 Pet's Name

Species

Cat Dog Other

Breed

Colour

Sex

Female Male

Spay OR Neuter

Yes No

Date Of Birth

Vaccines up to date?

Yes No

General health ?

#3 Pet's Name

Species

Cat Dog Other

Breed

Colour

Sex

Female Male

Spay OR Neuter

Yes No

Date Of Birth

Vaccines up to date?

Yes No

General health ?

I hereby acknowledge and agree to the terms and conditions set forth. By signing below, I confirm my acceptance and understanding of these terms.
A DEPOSIT MAY BE REQUIRED, AND FINAL BILLS ARE UPON RELEASE OF THE PATIENT. NO BILLING OR PAYMENTS PLANS.

Date

Signature Of Owner

By clicking SUBMIT you consent to receiving SMS messages from Dunbar Animal Hospital. Messages and Data rates may apply. Message frequency will vary. Reply Stop to Opt-out of messaging. Reply Help for Customer Care Contact Information. I have read and acknowledged the Privacy Policy.

3518 W 41st Ave, Vancouver, BC, V6N 3E6, Canada

Please use the form below to book an appointment with us. Your appointment will be confirmed once you receive our confirmation. You can also download the form using this link