New Client Form

Name: Neighbourhood Pet Clinic
Address: 746 Waterloo Street, London, ON, N6A 3W3, Canada
Telephone: 519-649-0080
Price range: $

We look forward to seeing you soon.

Register your pet.

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). You can also download and complete your form by clicking here.

Name *

First

Last

Email *

Home Phone

Cell Phone

Work Phone

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

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.

Do you have a preferred location? *

Note: All "neighbours" registered with Neighbourhood Pet Clinic have the flexibility to go to any Neighbourhood Pet Clinic location for care. If you have a preference, it will be noted on your account for your convenience going forward.

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 explain.

Name of Furry Family Member: *

Species

Cat
Dog
Other

If Other, please explain.

Pet's Age / Date of Birth

Pet's Breed

Pet's Colouring

Pet's Sex *

Male
Male - Neutered
Female
Female - Spayed
Unknown

Have you attended a different veterinary practice in the past? *

Previous Veterinary Practice: *

Please use this area to provide any relevant information about your pet (allergies, medical conditions, medications, etc.)

Do you have another pet to add?

Name of Furry Family Member:

Species

Cat
Dog
Other

If Other, please explain.

Pet's Age / Date of Birth

Pet's Breed

Pet's Colouring

Pet's Sex *

Male
Male - Neutered
Female
Female - Spayed
Unknown

Previous Veterinary Practice:

Please use this area to provide any relevant information about your pet (allergies, medical conditions, medications, etc.)

Do you have another pet to add?

Name of Furry Family Member:

Species

Cat
Dog
Other

If Other, please explain.

Pet's Age / Date of Birth

Pet's Breed

Pet's Colouring

Pet's Sex *

Male
Male - Neutered
Female
Female - Spayed
Unknown

Previous Veterinary Practice:

Please use this area to provide any relevant information about your pet (allergies, medical conditions, medications, etc.)

Phone

Drop us a line!

Complete the form below to email a message to our team. If this is an urgent situation, please call us directly at 519-649-0080.
CLICK HERE to contact Blue Cross by Neighbourhood Pet Clinic.

Client Type: *

New Client
Existing Client

Name *

First

Last

Email *

Phone

How can we help you? *

Message

Appointment Request

Are you a new or existing client?

New Client

Existing Client