Queensville Veterinary Clinic - New Client Form - Queensville Veterinary Clinic

* Indicates required field

Name *

First

Last

Spouse *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Alternate Contact number *

Email address *

Pet's Name *

First

Last

Breed *

Choose One *

Male Female Spayed Female Neutered Male

General History on your pet *

Do you have pet insurance? If so, with which company? *

Policies
1. All pets are required to be under control. Either on a leash or in a carrier. If you need to borrow a leash or carrier, just let us know we will be happy to provide one.
2. Full payment is required at the time services are rendered. We accept: Amex, Cash, Interac, Mastercard and Visa.
3. Queensville Veterinary Clinic does not share client or patient information, unless you give us permission. Permission is assumed for third parties like pet insurance companies, other veterinary facilities, support services (groomers or boarding facilities) of whom may require information from us to provide these services for you.
4. A Personal Information Privacy Policy is in effect at Queensville Veterinary Clinic. Please read our consent form

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New Client Information Form

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