New Client Form

New Client Intake Form

**IF THIS IS AN EMERGENCY, PLEASE DO NOT FILL OUT THIS FORM. INSTEAD, PLEASE CALL 778-403-7716 FOR ASSISTANCE**

Welcome and thank you for your interest in receiving pet care at Eagle Hill Animal Hospital
The information in this form will help speed up the process of creating your profile and to identify
your current pet concerns.

Owner Information

Full Name(Required)

Co-Owner Full Name

Phone(Required)

Do you have an appointment already booked? If so, when?(Required)

If it doesn’t apply just say ‘N/A’.

Name of your current Veterinary Practice(Required)

We will forward medical records to this practice.

How did you hear about us?(Required)

Address(Required)

Street Address Address Line 2 City Province Postal Code

Your Emergency Contact (if something happens to you, while you are here)

Full Name(Required)

Phone(Required)

Relationship(Required)

Pet Information

Pet's Name(Required)

Breed

Species (i.e. k9, feline)(Required)

Colour

Sex

Date of birth/Age

Date of last vaccines (if applicable)

What vaccines were given? (if applicable)

Is your pet on any medication or supplements?

Does your pet have/had a medical condition?

What food (brand) does your pet eat?

Does your pet have any allergies or drug reactions?

Additional notes about your pet

Consent Signature (Your Name)(Required)

If you give consent to the above, please provide your name and pet’s name so that we can appropriately credit you and your pet!

Consent Signature: Pet's Name(Required)

Comments

This field is for validation purposes and should be left unchanged.

New Client Intake Form

New Client Form

Owner Information

Your Emergency Contact (if something happens to you, while you are here)

Pet Information

Learn about what to expect before your visit