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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 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). The required sections have a red * asterisk.
Owner's Name
Name
*
First
Last
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Åland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darrussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Swaziland)
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Réunion
Romania
Russia
Rwanda
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
US Minor Outlying Islands
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Country
Day-Time Phone
*
Evening 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
Other
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
*
Dog
Cat
Rabbit
Ferret
Bird
Reptile
or if other species
Breed (if known)
Color
Date of Birth or Age (if known)
Special Identification (tattoo, microchip, etc.)
Sex
Neutered Male
Spayed Female
Male
Female
Unknown
Previous Veterinary Practice (if any)
COVID-19 Appointment Protocol
*
I hereby acknowledge for the saftety of clients and staff, clients are not allowed in the building. Client are required to call the main number when arriving at the parking lot but remain in their vehicle. Mask are required to be worn for all face to face interactions and while entering the foyer to pick up medications. I understand PVC is only accepting credit cards no cash or check until further notice.
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
*
I hereby acknowledge when I schedule an appointment and fail to show, call or notify Pawsteps of my inability to keep this appointment time, it impacts their ability to provide services to both my pet and other clients. I understand a $50.00 fee will apply to my account if multiple appointments are missed without proper notification.
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.
Please sign with your full name
*
New Clients
New Client Registration Form
Our Policies
About Us
Our Doctors
Our Support Staff
Services
Daycare and Boarding Facility
Preventive Healthcare Visits
Wellness Screening
Nutritional Counselling and Prescription Diets
Diagnostic Services
Digital Imaging
Pet Dentistry
Preventive Dental Care
Surgical Services
In-house Pharmacy
Client Education
Laser therapy
Sedation
Microchip Implantation
End-of-Life Pet Care
Adopting & Rehoming Pets
Pet Health
Pet Health Library
How-To Videos
Pet Health Checker
Pet Food Recalls
Product Recalls
Pet Insurance
News
Emergency
Contact Us
Make an Appointment
Online Pharmacy
Curbside Care