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New Client Registration Form
Thank you for choosing 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).
Owner's Name
Name
*
First
Last
Address
*
Street Address
Address Line 2
City
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Province
Postal Code
Home phone
*
Mobile Phone
*
Email
*
Enter Email
Confirm Email
Co-owner's Name & Contact #
Name
First
Last
Phone
How did you find out about our practice?
*
Clinic Location
Personal Referral
Internet Search / Website
Yellow Pages
Clinic Sign
Newspaper / Print Media
If Personal Referral, is there someone we can thank for this referral?
Reason for this appointment
*
New Pet Owner
New to the area
Second opinion - have you asked your regular vet if you should be seeing a Veterinary Specialist for your second opinion, Or do you want a second opion from us a general practice
Not able to see my own vet - you may be charged an additional urgent appointment fee for the extra time it take to review previous case files and submit our finiding back to your regular vet.
If you are coming because you are not able to see your own vet, please clarify if this is a new condition that is an emergency or an ongoing condition.
Pet Information
Pet's Name
*
Species
*
Dog
Cat
Breed (if known)
*
Color
*
Date of Birth or Age (if known)
*
Special Identification (tattoo, microchip, etc.)
Gender
*
Neutered Male
Spayed Female
Male
Female
Unknown
Previous Veterinary Practice (if any)
*
Please contact any vet clinic you have visited in the past and ask them to forward your records to us via email. It is VERY important to have all previous records prior to your exam with us. List below all vet clinics that have seen your pet so we can make sure we have received all the records or follow up with them if needed. Our email is info@acah.vet
Date of last vaccines (if known)
MM
DD
YYYY
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
Is your pet on any medication or supplement?
*
Yes
No
If Yes, please list the medication or supplement
Does your pet have allergies or drug reactions?
*
Yes
No
If Yes, please list the allergies and reactions
Does your pet show signs of aggression?
*
Yes
No
If Yes, do they need something to calm them for an appointment?
Does you have pet insurance?
*
Yes
No
If Yes, which company and what is your policy number?
Would you like us to call you or if you already have an appointment, when is it for?
*
Cancellation Policy
*
1. CANCELLATION within 24 HOURS of APPOINTMENT time/Charge for late arrival - $42.00
2. NO-SHOW for APPOINTMENT time - $42
3. NO-SHOW for SURGERY time - $60.00
We require a MINIMUM of 24 hours’ notice of a canceled appointment. We appreciate your consideration and understanding of this policy.
I agree to the cancellation policy
Consent to Policy
*
IMPORTANT COVID-19 HOSPITAL PROTOCOL:
To keep our staff and clients safe, we are working on a ONE PERSON PER PET POLICY. We ask that only one person be in the exam room, or waiting room at a time. When you arrive at the hospital please CALL THE CLINIC and the reception team will let you know you know when it is safe to come inside. Please do not enter the hospital if there are people in the waiting area.
PLEASE BRING YOUR PHONE WITH YOU.
If you are showing signs of cold, flu, or have traveled recently please inform us and we will be happy to reschedule your appointment.
Thank you and stay safe
The Veterinary Team at ACAH
I agree
At times during your pet’s visit, we may take pictures. Your consent here will act as authorization to use these pictures on Arnold Crescent Animal Hospital Facebook, Instagram and social media pages.
*
Yes
No
Shop Online
New Clients
About Us
Location & Hours
Emergency Process
Our Team
Our Community
Links
Book an Appointment
Services
Wellness and Vaccination Programs
Medical Services
Surgical Services
Anesthesia and Patient Monitoring
Additional Services
Pet Health
How-To Videos
Pet Health Library
Pet Health Checker
News
Forms
Surgical Consent
Hospitalization And In Clinic Procedure Consent
Compassionate Care Consent
New Client Registration
Beekeeper Resources
Yearly VCPR Form
Request AFB Prevention
Oxytetracycline Instructions & Calculator
Ontario Beekeeper Registration
Honey Bee Pests and Diseases
Ontario Treatment Recommendations for Honey Bee Diseases and Mite Control
Ontario Beekeepers’ Association
U. of Guelph’s Honey Bee Research Centre Videos
Book Appointment
