NEW CLIENT FORM

Please submit prior to your pet’s scheduled appointment to ensure all your details are correct in our system. Forms must be submitted in English.

First Name

Last Name

Phone

Street Address

City

Region/State/Province

Postal / Zip code

Country

Spouse/Relative First and Last Name:

Spouse/Relative Phone Number:

We need to build a medical record for your pet. We ask that you take a few minutes to provide us with some information for our files.

Pet's Name

Breed

Colour

Birthday Date required

Is your pet microchipped?

Yes

Does your pet have insurance?

Yes

What is the name of your previous veterinary clinic?

We will request records to get a complete medical history.

Any additional information you would like our doctors and team to know about your pet (allergies or previous reactions or any medication)

Would you like us to contact you to book an appointment? If you have an appointment booked already, please select NO

Yes (please contact me)

No (appointment booked already)

Recording Consent Form

Purpose of Recording: To enhance the quality of care and service provided at our practice, we may record interactions between you and our staff. These recordings will be used solely for care administration, quality assurance, and improvement purposes.

Consent: By selecting "I consent" below, you consent to the recording of your interactions with our staff. You acknowledge that these recordings will be used to improve the care and service provided by Lonsdale Place Veterinary Clinic and will be handled in accordance with our privacy policy. Privacy Assurance: All recordings will be securely stored and accessed only by authorized personnel. They will not be used for any purposes other than those stated above without your explicit consent.

Contact Information: If you have any questions or concerns about this recording consent, please contact us at 604-337-6603 or lonsdaleplacevet@gmail.com.

I Consent: I have read and understand the purpose of the recordings and consent to being recorded as described above

I Decline: I do not consent to being recorded. I understand that declining consent will not affect the care or services provided to my pet

Thank you for your understanding. If you select “I Decline,” please inform our staff upon arrival so that we are aware of your preference and can provide the best possible care while respecting your privacy and wishes.

PHONE: 604-337-6603

TEXT: 604-265-5457

NEW CLIENT FORM