New Patient Form

Welcome to Oak Animal Hospital, thank you for giving us the opportunity to care for your pet. In order to serve you better, please fully complete this form. If you have any questions, our receptionist would be happy to help!

OWNER INFORMATION

Full Name *

Phone Number *

Address *

City *

Province *

Postal Code *

Email Address *

How did you hear about us? *

Is there anyone we can thank for the referral? *

What is the name of your regular clinic, if applicable:

Have you left your regular veterinarian? If so, why?

Do you give us consent to post your pet(s) on our social media? *

Yes
No

Do you have pet insurance? *

Yes
No

CO-OWNER INFORMATION

Co-owner/Emergency Contact Full Name

Secondary Contact Phone #

PET INFORMATION

Pet's Name *

Sex *

Date of Birth or Age *

Breed *

Colour *

Date of last vaccines *

For cats:

Indoor
Outdoor

Presenting Problem/Concern: *

Please tell us briefly about any previous medical problems your pet has had. E.g. Past surgeries, illnesses, allergies *

Is your pet currently on any pre-visit interventions (medications): *

What is your pet’s interest for a positive visit? (treats, quiet, being outside): *

What triggers your pet to be stressed? (temperature taking, carrier, injections): *

What is the preferred location of exam? (inside carrier, outside): *

What type/brand of food are you feeding:

To keep costs of professional services at a minimum, all fees must be paid in full at the time of service. A deposit of 75% is required on all pets that must be hospitalized for laboratory testing or treatment. No billing credit is available through our office or over the phone. We accept: Cash, Interac, Mastercard, Visa, American Express, E-Transfer, Medicard.

Security Question *

I HAVE READ AND UNDERSTOOD THE PRIVACY POLICY *

New Patient Form

New Patient Form

OWNER INFORMATION

CO-OWNER INFORMATION

PET INFORMATION

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