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Client Registration Form
Thank you for considering our hospital as your pet’s provider of veterinary services. We are dedicated to maintaining the health of your pet and look forward to many future years together. Please complete this form as fully as possible prior to your first appointment which will help expedite the registration process and give us valuable insight in providing optimal care for your pet(s). The required sections have a red * asterisk. We will contact you to confirm a date and time that is as close to your request as possible if an appointment is requested. Appointments are typically booked 2 weeks in advance.
This form should only be used for new client registration. It will take at least 2 full business days after the time of submission of this form to be processed.
If we have not contacted you within 48 hours, please feel free to contact the practice by phone to confirm.
NOTE: THIS SHOULD NOT BE USED FOR EMERGENCIES PLEASE
CONTACT US
BY PHONE FOR URGENT CARE.
Step 1 of 5 - Client Information
20%
Client Information
Salutation
*
Prefer not to answer
Dr.
Mr.
Mrs.
Miss
Ms.
Name
*
First
Last
Day-Time Phone
*
Mobile Phone
Email
*
Enter Email
Confirm Email
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Swaziland)
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Réunion
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Ã…land Islands
Country
Would you like to add a second person to the account?
*
Yes
No
Co-owner's Name & Contact Number
Salutation
*
Prefer not to answer
Dr.
Mr.
Mrs.
Miss
Ms.
Name
*
First
Last
Phone
*
Section Break
How did you find about our practice?
*
Clinic Location
Personal Referral
Internet Search / Website
Yellow Pages
Clinic Sign
Newspaper / Print Media
Other
If Other, please specify:
*
If Personal Referral, is there someone we can thank for this referral?
*
Please use this area to give us any other relevant information about yourself or your family
Pet Information
Pet's Name
*
First
Last
Species
*
Dog
Cat
Breed
*
Colour
*
Date of Birth
*
Month
1
2
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Day
1
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Year
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2015
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2012
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1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Special Identification
This may include tattoo(s), a microchip, etc.
Sex
*
Neutered Male
Spayed Female
Male
Female
Unknown
Previous Veterinary Practice (if any)
*
Please include name and phone number of clinic
Previous Veterinarian (if any)
Date of last vaccines (if known)
Day
1
2
3
4
5
6
7
8
9
10
11
12
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16
17
18
19
20
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29
30
31
Month
1
2
3
4
5
6
7
8
9
10
11
12
Year
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
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1993
1992
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1988
1987
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1982
1981
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1966
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1962
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1958
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1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
What vaccines were given at this time
Are there any current or past medical conditions of which we should be aware?
*
Yes
No
If Yes, please comment on the condition(s) and indicate if they are current or past conditions
*
Do you have pet insurance?
*
Yes
No
What is your insurance company and policy number?
If you are unsure, please bring the information to your appointment
Would you like to sign-up with the Trupanion exam day offer?
The offer is a 30 day free trial with Trupanion
Yes
No
Not sure
Please use the following box to give us any other relevant information about your pet
Request an Appointment
Fill out date, time, and reason for visit to be contacted to confirm/schedule an appointment.
Appointments are scheduled 2 weeks in advanced.
Preferred Date
Date Format: MM slash DD slash YYYY
Preferred Time
:
HH
MM
AM
PM
Appointment Questionnaire
What is the reason for the visit?
*
Do you have any concerns you would like to be addressed during the appointment?
*
Any changes in your pet's activity level? (i.e. jumping, going up/down stairs, etc.)
*
How much daily exercise does your pet have?
*
How is your pet's urination?
*
Any blood in the urine, larger/smaller than normal, straining when peeing, etc.
How is your pet's bowel movement?
*
Any diarrhea, constipation, straining, redness, etc.
Is your pet experiencing any of the following?
*
Please check all that apply
Coughing
Sneezing
Vomiting
None
If your pet is experiencing any of the above symptoms, please list the frequency, colour, contents, consistency, duration if applicable
*
How is their water intake?
*
Excessive
More than normal
Normal
Less than normal
Unsure
Is there any changes in appetite?
*
Please list your pet's diet(s) and treats
*
How much are you feeding daily?
*
What is your pet's food habits?
*
Describe their daily routine with food. Be as detailed as possible. This may include but not limited to: Number of times they eat, when they eat, grazing the food, consuming the food all at once, texture preference, etc.
Does your pet have any food and/or seasonal allergies?
*
Yes
No
If yes, what allergies do they have?
*
Is your pet on any medication(s) or supplement(s)?
*
Yes
No
List any medications or supplements your pet is on
*
How often is tooth brushing done?
*
Every day
Once a week
2 to 3 times a week
Once a month
2 to 3 times a month
Less than once a month
Never
What are the facilities/locations that your pet frequents
*
Select all that apply
Boarding Facility
Daycare
Training Facilities
Dog Parks or Ravines
Cottage Country or Outside of Toronto
Outside of Ontario/Canada
None
List the facilities/locations
*
Is your cat indoor or outdoors?
*
Select the best answer
Strictly indoors
Mostly indoors, only goes out on porch/balcony
Both indoors and outdoors
Mostly outdoors
Strictly outdoors
In an emergency situation, would you like us to perform:
*
CPR (Cardiopulmonary Resuscitation)
DNR (Do Not Resuscitate)
Are there other pets in the household?
*
Yes
No
Please list the other pets/species in the home
*
Is anyone in the household allergic to peanuts?
*
Peanut butter may be used as a treat/distraction during the appointment.
Yes
No
Pre-Visit Questionnaire
As a Fear Free Certified Professional team, we want to make your pet's veterinary experience as enjoyable and as stress free as possible. As such, it's important for us to understand what your pet might find upsetting. The information will help us to adjust our care to better serve and comfort your pet.
Please answer the following questions to the best of your ability so we can take into consideration both your and your pet's preferences.
Does your pet show any reluctance getting in the carrier or car?
*
Yes
No
How and where does your pet travel in the car?
*
i.e. carrier, seatbelt, loose, etc.
During travel to the veterinary hospital, does your pet do any of the following:
*
Select all that apply
Select All
Eager and Excited
Subdued
Reluctant
Bark/meow
Hiding
Whining
Drool
Pant
Vomit
Tremble
Urine/bowel movement
Pacing
Other
None of the above
If Other, please specify:
*
Check any situation listed below that your pet has shown avoidance or dislike of in the past:
*
You can add additional comments at the end
Select All
Getting in their carrier
Entering the veterinary hospital
Other pets and/or people passing by while in reception/check-in
Waiting with other people and animals in the waiting area
Being approached by veterinary staff
Getting on the scale for a weight
Hearing the doorbell, overhead intercom, or phones ringing
Sounds coming from the back areas of the practice
Going into the exam room
Being put up on the table for examination
Having direct eye contact with the staff members
Loud voices during examination
Having a rectal temperature taken
The use of instruments such as the stethoscope (listen to the heart/lungs) or otoscope (to look in the ears)
Being taken out of the exam for procedures
Have not noticed/Unsure
Has not shown any avoidance/dislike before
How would you describe your pet around other animals and people?
*
Does your pet have any sensitive areas that s/he does not like to have touched by you or others?
*
Are there any procedures your pet has not liked having performed at the veterinary hospital in the past or that seemed difficult for you or the staff to do? If so, how did you pet react
i.e. Nail trims, weight, temperature, ear exam, blood draw
What are your pet's favorite treats?
*
We encourage to bring their favorite treats from home. We also have a selection of treats in clinic for them to explore.
Does your pet like to play with toys? If so, what kind?
Has your pet ever been presecribed any supplements or medication to help with a visit to the veterinary hospital?
*
Yes
No
What was it and what sort of results did you experience
*
Anything else you would like us to know?
Name
This field is for validation purposes and should be left unchanged.
Δ
Home
Clients
What to Expect
Take A Tour
New Client Registration Form
About Us
Team
Contact
Our Connections
For Our Neighbourhood
Services
All Services
Medical Services
Wellness and Vaccination Programs
Preventive Services
Surgical Services
Anesthesia and Patient Monitoring
Pain Management and Control
Microchip Pet Identification
Pet Health
Quality of Life Forms
Quality of Life Scale
Lap of Love – Quality of Life Scale
Quality of Life – Daily Diary
How-To Videos
Pet Health Checker
Pet Health Library
Links
Pet Insurance
Pet Food Recalls
Product Recalls
Online Store
Contact
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