REGISTER WITH US

Personal Details

Title *

First name *

Surname *

Address *

Postcode *

Telephone (home) *

Email address *

Your pet

Pet's name *

Species (e.g. cat, dog, rabbit) *

Breed *

Colour *

Sex *

Neutered *

Date of birth *

Current weight (if known) *

Comments *

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.

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.