Owner's Information

Primary Owner *

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Last

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Phone Number *

Do you consent to receiving text messages? *

Yes, I consent
No, I do not consent

At Orleans Veterinary Hospital we use text message appointment reminders to confirm upcoming appointments.

Email *

Email

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Co-Owner

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Last

Alternative Phone Number

How did you hear about us?

Please check all that apply.

Pet Information

Pet's Name *

Species *

Breed(s)

Colour *

Date of Birth or Approximate Age *

Sex *

Does your pet have any special identification?

Microchip, tattoo, etc.

Pet's History

Is your pet on any medications or supplements? *

Yes
No

If yes, please list them and their dosages:

Are there any current or past medical conditions of which we should be aware? *

Yes
No

If yes, please comment on the condition(s) and indicate if they are current or past conditions:

Is there anything else you would like us to know about your pet and their history?

Has your pet visited any other veterinary practices? If so, please list them.

By providing your previous vet clinic, you are consenting to us contacting that clinic on your behalf to obtain your pet's records.

Please attach any relevant medical records

Click or drag files to this area to upload. You can upload up to 3 files.

New Client Registration Form

Owner's Information

Pet Information

Pet's History

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Orleans Veterinary Hospital

Contact

Address

Hours of Operation

Pet Spa Hours

After Hours Emergencies