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Park Vet Hospital
Hope Valley
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Register With Us
Complete the form below to register your pet with our practice.
Title
(Required)
First name
(Required)
Surname
(Required)
Address
(Required)
Postcode
(Required)
Telephone (home)
(Required)
Email address
(Required)
Your pet
Pet's name
(Required)
Species (e.g. cat, dog, rabbit)
(Required)
Breed
(Required)
Colour
(Required)
Sex
(Required)
Male
Female
Neutered
(Required)
Yes
No
Date of birth
(Required)
Current weight (if known)
(Required)
Comments
(Required)
(Required)
I hereby authorise the veterinarians of Park Veterinary Hospital Ltd to examine, prescribe for and/or treat the above described pet(s). I assume responsibility for the charges incurred for the care provided. I also understand that payment is due in full at the time of treatment. Deposits may be required in some instances. Payment must be made by debit/credit card – note we do not accept American Express cards.
Previous Veterinary practice details
Were you registered at another veterinary practice? If so, please provide the following details so that we can obtain your notes:
Practice name
(Required)
Address of practice
(Required)
Was your pet registered under a different surname or address? If so, please provide these details or enter N/A:
(Required)
I agree that Park Veterinary Hospital can send for my pet's clinical history from my previous veterinary practice and may send me text/ email / post reminders, through partner organisations, when my pet’s vaccinations/flea/worm treatments are due. I understand that Park Veterinary Hospital may also be required to share my personal contact details and my pet’s clinical history in the event of a specialist referral or an insurance claim.
(Required)
Yes
No
Previous Veterinary practice details and/or Rescue Centre information
Please let us know if you have any accessibility requirements?
(Required)
.
Please note this consent is required to complete your registration. You may change your authorisation at any point; please inform reception if you wish to amend your preference.
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