Client Intake Form

IMPORTANT: Our hours of operation and on-site availability may vary throughout the day as we adapt to our current capacity.
Please call us at 905-884-1832 PRIOR TO YOUR ARRIVAL so we can advise whether we have a veterinarian on site to help you and your pet. Failure to call ahead may lead to delayed care for your pet as you may be diverted to another facility at the time of your arrival.

OWNER INFORMATION

Owner's Full Name *

Owner's Phone Number *

Co-Owner's Name

Co-Owner's Phone Number

Address *

City *

Province *

Postal Code *

Email Address *

Name of your regular veterinary clinic *

I consent to Vaughan-Richmond Hill Veterinary Emergency Clinic contacting my pet's regular vet for medical history *

Yes
No

Do you have pet insurance? *

Yes
No

PET INFORMATION

Pet's Name *

Species *

Breed *

Colour *

Date of Birth *

Gender *

Is your pet up to date on vaccinations? *

Yes
No

Is your pet up-to-date on their rabies vaccine? *

Yes
No

Security Question *

I HAVE READ AND UNDERSTOOD THE PRIVACY POLICY *