New Client Form

CLIENT INFORMATION

Owner's Full Name *

Co-Owner's Name

Address *

City *

Province *

Postal Code *

Cell Phone *

Co-Owner Cell

Home Phone

Email Address *

How did you hear about us? *

We send all vaccine and appointment reminders by email/text. You will receive an email after your initial visit which will allow you to update your communication preferences. If your information changes at any time, please inform one of our staff members in order to continue receiving reminders.

PET INFORMATION

Tell us about your pet(s) *

	Name	Breed	Colour	DOB/Age	Sex	Last Vaccinations	Clinic
1.
2.
3.

If your pet(s) has/have any previous medical issues, please list them here:

If your pet(s) is/are currently taking any medications, please list them here:

Do you have pet insurance? *

Yes
No

We love taking pictures of the wonderful pets we see at Aspen Animal Hospital. Do you authorize us to share photos of your pet on social media like Facebook and Instagram? *

Yes
No

What is the best way to contact you? *

If your pet has travelled out of province recently, please tell us where:

Do you have an upcoming appointment? *

Yes
No

Please feel free to ask our staff to provide you with a written estimate for today’s visit if you desire. ALL PROFESSIONAL FEES ARE DUE AT THE TIME SERVICES ARE RENDERED. We take the following payment methods: MasterCard, Visa, Debit or Direct Billing to Trupanion insurance. WE DO NOT ACCEPT CHEQUES OR AMERICAN EXPRESS. By providing your signature below you agree that as the rightful owner of the pet(s) listed you will pay in full all fees at the time of services rendered.

Signature *

Date *

Today

Security Question *

I HAVE READ AND UNDERSTOOD THE PRIVACY POLICY *

New Client Form

CLIENT INFORMATION

PET INFORMATION

Our Cookies

About Cookies

Cookie settings

Functional cookies

Analytics cookies

Marketing cookies