New Client Registration-RVS

First Name

Last Name

Email

Phone Number

Spouse/Partner

Is the above party authorized to make medical and financial decisions for your pet?

Yes

No

I agree to receive invoices, vaccination/appointment reminders, hospital information and other commercial electronic messages from Roblin Veterinary Services. I may withdraw my consent at any time.

Yes

No

Pet's Name

Age of Pet

Species

Canine

Feline

Other

Sex

Female

Male

Male Neutered

Female Spayed

How long have you owned your pet?

Previous veterinary practice

Is your pet currently up to date on vaccines?

Yes

No

Please use the following to give us any other relevant information about your pet (current medications, previous health concerns, diet, travel history, etc).

Payment in full is due at the time of services, unless previous arrangements with our office have been made. For hospitalized cases, a deposit of the low end of the treatment plan is required in advance and payment in full is due upon discharge from our hospital. We offer the following payment options: cash, cheque and credit card (Visa and Mastercard).

I have read and understand the financial policy and agree that I am over 18 years of age.

Your Signature

*

Date

New Client Registration

Financial Policy