New Client Form

To register as a client please complete the following form. Your responses to this form are only accessible by staff at Companion Animal Veterinary Hospital.

Completing this form online will allow us to add your details to our computer system prior to your visit. An appointment is required for your visit, to book an appointment either call us on 02 42 619 838 or use the contact form.

Owner details

This section is for your details, not your pet's

Title: *

First Name: *

Surname: *

Address: *

Enter the house number and street

Suburb: *

State: *

Postcode: *

Home Phone

Area Code:

Number:

Mobile Phone Number:

Work Phone

Area Code:

Work phone number:

Email address:

We won't share your email address. We will use it to send you information, reminders and to contact you.

How many pets do you have?: *

Pet's details

Pet's name: *

Species: *

Breed: *

Date of Birth: *

Sex: *

Male

Female

Is your pet desexed?: *

Are there any pre-existing health issues or allergies:

List any problems here

Do you have pet health insurance for this pet: *

Who is the insurer?:

2nd Pet Details

Pet's name: *

Species: *

Breed: *

Date of Birth: *

Sex: *

Male

Female

Is your pet desexed?: *

Are there any pre-existing health issues or allergies:

List any problems here

Do you have pet health insurance for this pet: *

Who is the insurer?:

Further Pets

Other animal's details:

Enter each pet's name, species, breed, age, sex, desexing status, and pet insurance details.

Declaration

I am 18 years of age or older

I will pay all fees owing at the time of discharge unless alternative arrangements have been made prior to discharge

I recognise that there are inherent risks with any veterinary procedure and that I have discussed or will discuss any concerns with the treating veterinarian prior to the procedure.

New Client Form

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