New Client Form

Please take a few minutes to fill out the form prior to your first appointment at Mill Lake Veterinary Clinic so we can get to know you and your pet.

Client Information

Client First Name *

Client Last Name *

Preferred Pronouns

Primary Contact Email Address *

Primary Contact Phone Number *

Secondary Contact First Name

Secondary Contact Last Name

Secondary Contact Preferred Pronouns

Secondary Contact Email Address

Secondary Contact Phone Number

Street Address

Apartment, suite, etc

City

Province

Postal Code

Pet Information

Pet's Name *

Pet Species *

Pet's Breed *

Pet's Colour or Coat Pattern *

Pet's Gender *

Pet's Approximate Age or Date of Birth *

Does your pet have any existing conditions you are aware of? Please describe them.

Is there anything we should know about your pet?

Name of Previous Vet Clinic

Do we have permission to contact your previous veterinary clinic to obtain your pet's medical records and vaccination history?

Is your pet insured?YesNo

Pet Insurance Provider

Pet Insurance Policy NumberIf you have multiple pets, please seperate their policy numbers with commas

Do you have any additional pets to add?

Second Pet

Pet's Name

Pet Species

Pet's Breed

Pet's Colour or Coat Pattern

Pet's Gender

Pet's Approximate Age or Date of Birth

Does your pet have any existing conditions you are aware of? Please describe them.

Is there anything we should know about your pet?

Third Pet

Pet's Name

Pet Species

Pet's Breed

Pet's Colour or Coat Pattern

Pet's Gender

Pet's Approximate Age or Date of Birth

Does your pet have any existing conditions you are aware of? Please describe them.

Is there anything we should know about your pet?

Additional Information

Is anyone in your household (human or pet) allergic to peanuts or are there any other allergies we should be aware of?

Please indicate other allergies.

Do you currently use boarding or daycare facilities, veterinary specialists, or have any other affiliations you'd like us to know about?

There may be times we would like to share a photo or video of your pet with our social media sites (including but not limited to our website, Facebook, Instagram, etc.) Please indicate your wishes below:

Notification Settings - We use text messages and email to communicate appointment reminders, as well as your pet's health reminders (vaccines, exams, etc), and occasional emergency closure notices. If you would like to opt OUT of these reminders, please indicate below. *

How did you hear about our clinic? *

Who referred you to our clinic

Tell us how you heard about our clinic.