New Client Form

Welcome! Thank you for giving us the opportunity to care for your pet. We are happy to answer any questions you have about your pet’s health. To ensure the best possible care, we ask that you take the time to fill in this form prior to your visit.

CLIENT INFORMATION

Full Name *

Spouse/Additional Owner

Address *

City *

Province *

Postal Code *

Phone Number *

Email Address *

PET #1 INFORMATION

Pet's Name *

Your pet's species

Your pet's breed

Your pet's age

Your pet's gender

Spayed/Neutered

Yes
No

Colour

Pet Insurance Company/Policy Number (if applicable)

Previous clinic(s) (if applicable, we will contact them for previous medical history)

Vaccination History (date and type of vaccine given)

Current Medication/Supplements

Current Diet (i.e. Iams Adult Lrg Breed)

Appointment Date and Time (if already booked)

Reason for Visit

Is there anything else you would like us to know about your pet? (i.e. anxiety, behaviour, etc.) At Fairmont, we strive to make every visit as pleasant and fear free as possible.

PET #2 INFORMATION

Pet's Name

Your Pet's Species

Your Pet's Breed

Your Pet's Age

Your Pet's Gender