New Client Form

New Client Intake Form

Welcome and thank you for your interest in receiving pet care at Don Valley Animal Hospital!
The information in this form will help us create your profile and identify your current concerns. We
will follow-up within 48 hours to schedule your first visit. If this is an emergency, please call us
for direct assistance

Owner Information

Full Name(Required)

Phone(Required)

How did you hear about us?(Required)

Address(Required)

Street Address Address Line 2 City Province Postal Code

Co-owner Information

Co-owner Full Name

Phone

Pet Information

Pet's Name(Required)

Breed

Species(Required)

Colour

Sex(Required)

Date of Birth(Required)

Date of last vaccines(Required)

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?

Where was your previous veterinary hospital or clinic?

We require your previous veterinary hospital or clinic in order to request records to better understand your needs.

Reason for coming to our clinic?(Required)

Insurance provider

Please let us know who your insurance provider is if you have one.

Additional notes about your pet

Consent Signature (Your Name)

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

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We look forward to welcoming you!

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