New Client Form

We thank you for giving us the opportunity to care for your pet. In order for us to meet your needs better, please take a moment to fill out the following form.

 

CLIENT INFORMATION

We will only use your e-mail address to send out vaccination reminders.

Best time of day to be contacted


CO-OWNER INFORMATION

PET INFORMATION

Tell us about your pet(s): *

 
Name
 

Species
 

Breed
 

Colour
 

DOB/Age
 


Sex
 

 1. 
 2. 
 3.
 4.
 5.
 

HOSPITAL POLICY

 

Please read the following and sign below indicating you understand our hospital policies.

 

Disease Prevention
In order to prevent the spread of infectious disease and parasites, hospitalized patients (grooming/surgery/medical work up) MUST be up to date on all core vaccinations and free of internal and external parasites. In the event that a hospitalized patient is found to be carrying parasites of any kind, the pet will be treated immediately and the owner will be responsible for the cost of treatment.

 

Payment for Services Rendered
Payment for services rendered is due upon discharge of the patient. An estimate will be provided, but it is an estimate not a 'quote'.

 

Method of Payment
Elmvale Veterinary Hospital can take payment in the form of Cash, Debit Cards, Visa and MasterCard only.

 

Medical Records
As per the College of Veterinarians of Ontario, medical records (including radiographs) are the property of the veterinary clinic and are to be maintained in the clinic for 5 years. Should you wish to have your files forwarded to another veterinary clinic due to a more or referral, we would be happy to send copies of the records to the facility. Radiographs can have copied mage, costs incurred will be the responsibility of the pet owner.

 

By signing below, you are confirming that you have read and understood the above hospital policies.

 

Today

CONSENT FOR COMMUNICATION & MEDIA USE

The Canadian Anti-Spam Legislation (“CASL”) prohibits the sending of any electronic messages that are commercial in nature unless the sender has received the recipients' express consent prior to sending the message. Our practice therefore requires your written consent to send you any electronic messages. While most of our communications are related to your pet’s health, some may contain commercial activities such as promotions, special events, or fundraising activities. Please note that if you do not consent, you will not receive ANY communications from our practice on any matter.
 

We also like to feature patients on our social media account(s), whether it be a success story, an interesting visit or the animal is just too cute not to. For us to responsibly take these videos and/or pictures we need to be granted your permission to use them on our social media account(s). Please keep in mind that your consent can be revoked at any time, but images and videos used during active consent will remain, though no further use of the images or videos will take place. A removal request can be made and will be reviewed, depending on the video and/or image we will try and remove it as requested but, in some cases, removal will not be possible, so please bear that in mind when consenting.

 

Please indicate what forms of communication are allowed: *

 

Note that phone calls must be allowed as that will always be the first contact method used in an emergency. Also, if you opt-out of email, you will not receive invoices, estimates, or reminders.

A. Service Communications
(These are used for appointment reminders, updates about your pet’s care, or billing-related matters.)
 

Print
Email
SMS/Text
Phone Calls


B. Marketing & Promotional Communications
(These are optional and include educational materials, newsletters, promotions, and social media use.)
 

Newsletter
Use of Pictures/Videos
Security Question *