Owner's Name

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Day-Time Phone*

Evening Phone

Mobile Phone

Email*

Enter Email Confirm Email

Date of Birth*

Must be 18 years or older.

Co-owner's Name & Contact #

Name

First Last

Phone

How did you find out about our practice?

If Other, please specify:

If Personal Referral, is there someone we can thank for this referral?

Please use this area to give us any other relevant information about yourself or your family

Pet Information

Pet's Name*

Species*

or if other species

Breed (if known)

Color

Date of Birth or Age (if known)

Special Identification (tattoo, microchip, etc.)

Sex

Previous Veterinary Practice (if any)*

Additional Pet Info (Optional)

Pet's Name

Species

or if other species

Breed (if known)

Color

Date of Birth or Age (if known)

Special Identification (tattoo, microchip, etc.)

Sex

Previous Veterinary Practice (if any)

PHOTOGRAPH & PET INFORMATION RELEASE

I hereby grant PawSteps Veterinary Center (henceforth known as PVC), its representatives and employees the absolute and irrevocable right to use my pet's names and images for any lawful purpose, including for example such purposes as publicity, illustration, marketing, web content, and social media. I hereby acknowledge receipt of adequate consideration and waive the right to charge for use of the pictures, to inspect, or approve the images prior to any form of usage. I understand that the images may be modified to be used as design elements.

TREATMENT POLICY*

I hereby authorize PVC to render any treatment which is deemed critical to my pet's health while in their custody. I understand that in the event of any unforeseen or emergent circumstances, PVC will make every reasonable attempt to contact me or my agent before proceeding with treatment. I understand that I will be financially responsible for all emergency procedures including the Estimate of Treatment provided in person or via telephone.

PAYMENT POLICY*

All fees MUST be paid in full at the time services are performed or upon discharge from PVC. A deposit for expected treatment is required for all pets admitted to PVC. A late fee will be charged on all unpaid balances at a rate of 20% APR. Accounts will be turned over for collection if unpaid for more than 90 days. All costs of collection will be added to the outstanding balance.

NO-SHOW POLICY*

When an appointment is scheduled and a client fails to show, call, or notify Pawsteps of their inability to keep this appointment time, it impacts our ability to provide services to both the pet and other clients. Fees for missed appointments are as follows: 1st - $75, 2nd - $150, 3rd - $200.00, 4th - Dismissed as client. No Show fees must be paid prior to any services being rendered and accounts past 60 days will incur a 1% per month interest fee. Regular appointments require a minimum of 12 hour notice and all surgeries require 48 hour notice, fee for surgery cancellations/no show $250.

ZERO TOLERANCE POLICY*

I hereby acknowledge PawSteps Veterinary Center’s Zero Tolerance Policy. Anyone giving verbal abuse to members of staff, either in person, over the telephone or online will be sent a letter from our Practice Manager advising that this behaviour will not be tolerated and dismissed as a client of PawSteps Veterinary Center.

Are you over the age of 18 ?*

Yes
No

Please sign with your full name*

New Client Registration Form

Owner's Name

Co-owner's Name & Contact #

Pet Information

Additional Pet Info (Optional)

Contact Us

Hours of Operation

Emergency Info