Register with us

Title(Required)

First name(Required)

Surname(Required)

Address

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)

Neutered(Required)

Date of birth

Current weight (if known)(Required)

Comments(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

Address of practice

Was your pet registered under a different surname or address? If so, please provide these details:

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

.

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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