New 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 the form as much 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). If you have several pets, please complete one form for each pet.

If you have any questions, please give us a call at 905-285-0002 and one of our team members will be happy to assist you.

CLIENT INFORMATION

How did you hear about us? *

Our Technicians and Animal Care Attendants are specially trained to assist the veterinarian while examining your pet. You are welcome to assist holding your pet during an examination if you wish, but must accept the responsibility for the risk if your pet bites or scratches you, or any of your family members, while at our hospital.

 

Would you like to hold your pet during the physical examination? *
When practicing fear-free veterinary care, we often use peanut butter as a reward. Do you or anyone in your household have concerns about your pet having peanut butter? *
Do you consent to being sent text messages regarding your pet? *
May we have permission to use in-hospital photos of your pet on social media? *

PATIENT INFORMATION

Do you have other pets in your household? *

PERSONAL INFORMATION POLICY CONSENT FORM

I understand that Westbridge Veterinary Hospital Professional Corporation has a Personal Information Policy in accordance with the requirements of the Personal Information Protection and Electronic Documents Act. By signing below, I am consenting to the collection, use and disclosure of my personal information (such as my home telephone number and address) in accordance with the purpose set out in the policy, which include the following:

 

  • Maintaining complete and accurate client files, and complying with the requirements of the College of Veterinarians of Ontario, the Veterinarians Act and regulations under the Act;
  • Providing goods and services to you, the client, including contacting clients to schedule appointments and follow-ups on patient treatment, billing for goods and services and notifying clients about new services and promotional offers.
  • Communicating and working with third parties providing veterinary medical or other services to you, such as other veterinary facilities and insurance companies which may pay for all or part of the cost of such services.

 

I understand that:

 

  • My personal information will not be used or disclosed for purposes other than those for which it was collected, except with my consent, or except where use or disclosure is required by law.
  • I have the right to view my personal information and have it amended, if inaccurate or incomplete.
  • We would like to use your email to send you newsletters, reminders, invoices, and medical updates, in order to cut down on paper use and be kind to the environment. By providing your email address, you consent to receive these emails.
  • I give Westbridge Veterinary Hospital permission to disclose types of vaccines given to my pet, and vaccine expiry dates to the following organizations that work with my pet:
     


 

Security Question *