New Client Form

If you are a new client bringing your dog or cat to East End Veterinary Medical Centre for the first time, we will have you fill out our Client Information Form upon arrival. In the interest of saving time, we have made this form available to you online. Please feel free to fill out the form prior to your arrival, and either print it out to give to us, or send it to us at info@eevmc.com.

Best Way To Reach You? Home#Cell#Work##Email
PET INFORMATION:
SEX: MaleFemaleSpayedNeutered
AGE:
SPECIES: DogCat
IF CAT:
Number of Pets in Household?
Is your pets previous health record available?YesNo
Statement of Ownership and Consent: I am the owner and/or agent for the above animal and have the authorization to consent to treatment if and when it is necessary. I also assume financial responsibility for all charges incurred, and agree to pay all such charges at the time services are rendered or as arranged prior to examination and/or treatment.
SIGNATURE ( typing in your name acts as your signature )