Date:
Client surname:
Initials or Title:
Email address:
Address:
Postcode:
Home Tel No:
Other Tel No:
Where did you hear about us?
How did you find our telephone number?

PET DETAILS (Number of Pets):
 
Name of Pet:
Breed:
Male or Female:
Colour:
Neutered:
Age or Date of Birth:
Insurance Company:

IF ADULT, DATE OF NEXT VACCINATION:
CURRENT MEDICATIONS AND RECENT TREATMENTS:

Please note that pets requiring repeat prescriptions will need to be assessed every four months for which there is a prescription evaluation fee.

Where did you get your pet from?:
Previous Vet's Name (if relevant):
Reason for visit:

Please submit your surname and the pet details for subsequent pets.

TERMS AND CONDITIONS OF BUSINESS

All fees MUST be paid for at the time of consultation or discharge after treatment. Payment can be by Cash Delta, Switch, Visa or Access. We operate on our standard terms and conditions of business. If you wish to see a copy, please ask the practice manager.

Please do not send children under 16 yrs with pets to the Centre unless by prior arrangement with the Veterinary Surgeon. Please do not send third parties with pets, as treatments can be complicated by lack of accurate history.

For safety reasons, please ensure that your pet is adequately restrained whilst on the premises – dogs should be on a lead and cats, rabbits, birds etc in a suitable carrier.

Thank you.