New Client Registration Form

Thank you for considering Scholl Animal Hospital as your pets provider of veterinary care. Please complete this form to the best of your ability prior to booking an appointment. If you have any questions feel free to call our office at 519-473-2288.

Owner's Name & Contact Information

Name*

First Last

Day-Time Phone*

Evening Phone

Mobile Phone

Email*

Co-Owner's Name & Contact Information

Name

First Last

Phone

Email*

Address

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

How did you find out about our practice?

Who referred you to us? Please let us know so we can thank them.

Please use this area to give us any other relevant information about yourself or your family

Pet Information

Pet's Name*

Species*

Breed (if known)*

Color

Date of Birth or Age (if known)

Special Identification (tattoo, microchip, etc.)

Sex

Previous Veterinary Practice (if any)

Previous Veterinarian (if any)

Why are you looking to find a new vet?

Date of last vaccines (if known)

What vaccines were given at this time

Is your pet on any medication or supplement?

Yes
No

If Yes, please list the medication or supplement

What food does your pet eat?

does your pet have allergies or drug reactions?

Yes
No

If Yes, please list the allergies and reactions

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

Post Excerpt

Please use the following box to give us any other relevant information about your pet