McGilvray Veterinary Hospital
1525 Avenue Road
Toronto, ON M5M 3X3
(416)783-6131


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<p><span style="font-size: 12pt; font-family: 'Times New Roman'; mso-fareast-font-family: 'Times New Roman'; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA"><em><font size="7"><font color="#008080">McGilvray Veterinary Hospital</font></font> </em></span></p>

McGilvray Veterinary Hospital

Welcome to Our Site

Form - Online Registration Form

OWNER INFORMATION
Selection (required)
Mr.
Mrs.
Ms.
Miss
Dr.

Name (required)
First Name (required)
Last Name (required)
Address (required)
Street Address (required)
City (required)
State/Province (required)
Zip/Postal Code (required)
,
Phone (required)
Phone TypePhone Number (required)
Phone
Phone TypePhone Number
Phone
Phone TypePhone Number
E-Mail Address :
Emergency Contact Name & Telephone #

Whom May We Thank for Referring You?

PET INFORMATION
Pet Name (required)

Dog or Cat (required)
Dog
Cat

Sex (required)
Male
Female

Neutered/Spayed?
Y
N

Breed (required)

Colour (required)

Date of Birth (eg: Jan. 1, 2007) (required)

Breeder

Is your pet microchipped? (required)
yes
no

Do you have pet insurance? (required)
Petplan
Petcare
Vetinsurance
Other
No, but I'm interested
No, not interested
If other, which insurance company have you chosen?

VACCINATION AND MEDICAL HISTORY
Date previous vaccines administered (required)

Previous Veterinary Clinic (if applicable)

Does your pet have any health concerns and/or allergies we should be aware of?

When (approximately) do you plan to visit with us? (required)

Which doctor do you wish to see?
any doctor
Dr. Tate
Dr. Owen
Dr. Marks
Dr. Hodges


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