OWNER'S First Name *

OWNER'S Last Name *

Phone Number (Mobile Preferred) *

Confirm Phone Number *

Email Address *

Confirm Email Address *

Address *

City *

Postal Code *

____________________

Dog's Name *

Sex *

Male
Female
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Pet's Date of Birth *

Breed *

Colour *

Estimated Adult Weight (lbs): *

____________________

Please review the following questions regarding your pet's health carefully. Submitting incorrect or incomplete information will delay your appointment booking.

Does your pet have a regular veterinarian? *

YES

Regular Veterinarian's Name:

Clinic Name and Address:

Does your pet have any health concerns? *

Is your pet taking any medication (not including flea/tick/heartworm prevention)? *

Does your pet have a hernia? (Please note, we only offer hernia repairs for females at an upcharge of $40): *

YES
NO
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(Female Dogs Only) Date of last heat cycle (N/A if no heat yet):

(Female Only) Is there a possibility of pregnancy?:

YES
NO
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MALE DOGS: Are both testicles descended? If not, the waiting time may be increased and up to a $200 upcharge will apply. (Female dogs please select N/A) *

Male - YES
Male - NO
Female - N/A
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Does your dog require a muzzle? *

Yes
No
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Is your pet in ideal body condition? *

Review Chart Below

YES
NO
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Ownership Declaration *

I declare ownership and responsibility of the animal listed on this form. All forms, certificates and communication will be addressed to me at the ownership information I provided above. I declare that I am of legal age in the province of Ontario (18).

Cancellation List *

I understand that payment must be made in full to be added to the cancellation list, and I will not be contacted for an earlier appointment unless payment has been made. An invoice will be sent upon appointment confirmation.

PLEASE REVIEW THE CURRENT WAIT TIMES AT THE TOP OF THIS PAGE BEFORE SUBMITTING THE FORM.

Questions and Comments

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