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for any of our four locations.

Appointment Request

Client Type:

New Client
Existing Client

Name *

First

Last

Email *

Phone *

Is this number a home phone or cell phone? *

Home Phone
Cell Phone

Cell Phone

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Preferred Method of Contact:

Email
Phone

Secondary Contact Name

First

Last

Secondary Contact Phone

Is this secondary contact your spouse?

Yes - this person will share my account
No - Please add as emergency contact only
Other - please specify

If other, please specify: *

Name of Your Furry Family Member: *

Species: *

Dog
Cat

Pet's Breed *

Pet's Colouring *

Sex *

Male
Neutered Male
Female
Spayed Female

Pet's Age / Date of Birth

Does this furry family member have pet insurance? *

Would you like to add a 2nd pet? *

Yes
No

Name of Your Furry Family Member: *

Species: *

Dog
Cat

Pet's Breed *

Pet's Colouring *

Sex *

Male
Neutered Male
Female
Spayed Female

Pet's Age / Date of Birth

Does this furry family member have pet insurance? *

Do you have a previous veterinarian? *

Yes
No

Previous Veterinarian's Name *

Clinic Location *

Preferred Appointment Day(s): *

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

Our current schedule is as follows: Mon - Fri: 8 AM - 7 PM Sat: 9 AM - 4 PM

Preferred Appointment Time: *

9:00 AM - 12:00 PM
12:00 PM - 3:00 PM
3:00 PM - 6:00 PM

Our current schedule is as follows: Mon - Fri: 8 AM - 7 PM Sat: 9 AM - 4 PM

Optional: Please select your preferred clinician(s):

Any/no preference
Dr. Alec
Dr. Wineeta (Westmount only)
Dr. Navid
Dr. Nicole (Sunningdale only)
Dr. Jeff (North London only)
Dr. Sikander
Dr. Bernadett
Unsure/please specify:

Looking for another doctor or not sure of your vet's name? Let us know; we can check your pet's medical records to help determine who you've seen in the past. Please note that if not listed above, your preferred veterinarian may have limited availability or be by referral-only. Additionally, Dr. Emily is on parental leave as of September 2025.

Unsure/please specify

Reason for appointment: *

Phone

Four Locations + Pet Shuttle Serving London, Ontario
Mailing Address: 746 Waterloo St, London Ontario N6A 3W3

WESTMOUNT | NORTH LONDON | SUNNINGDALE | BLUE CROSS | MOBILE SERVICES

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