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Dog in Farm

FILL OUT THE NEW CLIENT INFORMATION FORM

 

Bring your cat or dog to our veterinary clinic for a regular check-up and we will make sure to give it the right treatment or vaccination, if necessary. You can count on us to provide you with same-day appointments. Contact Queensville Veterinary Clinic to book an appointment.

Fill in the below Details

* Indicates required field.

Name*

Spouse

Address*

Phone Number*

Alternate Contact Number

Email Address*

Pet's Name*

Breed

Choose One*

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 and 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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