WELCOME TO MCGILVRAY VETERINARY HOSPITAL

Please take a moment to print and complete this owner & pet registration prior to your first visit. 

Last Name: .........................................  First Name................................. (Mr./Mrs./Miss/Ms/Dr.)

Permanent Address..............................................................................................................................

City............................................  Province.................................... Postal Code .................................

Home Tel: ............................................  Business Tel: .......................................

Alternate Tel: ..................................................   Email Address: .......................................................

Emergency Contact Name:..........................................  Phone #:.......................................................


WHOM MAY WE THANK FOR REFERRING YOU?

Name:.......................................................................  Professional Referral.........................................

Other........................................................Which Doctor would you like to see?..............................

PET INFORMATION

Pet Name..............................................  Sex..........  Spayed / Neutered      Approx. Weight............

Dog / Cat      Breed......................................... Colour.................................  Birth Date.......................

Breeder.............................................   Microchip ............................  Pet Insurance............................

VACCINATION

Date Vaccines Administered..........................................  Clinic ..........................................................

Special Past History/medical concerns................................................................................................

Allergies ...................................................................................................................................................

Reason for Today's Visit........................................................................................................................

METHOD OF PAYMENT

Cash.......... Visa.......... Mastercard.......... Cheque.......... Interac/Debit Card..........

I understand and agree to the fact that it is the policy of this Hospital to receive payment as services are rendered and where major medical/surgical expenses are anticipated, a deposit will be required prior to proceeding.

Date.................................................     Signature..............................................................................

For the safety of all pets and people, please keep your pet restrained by leash or carrier at all times.
Thank you for your co-operation in this regard.