Pet Appointment Form

To help us with your pet's upcoming appointment, please take a few moments to complete the following questionnaire.

 

PET & OWNER DETAILS

REASON FOR APPOINTMENT

Has your pet experienced any of the following symptoms?

 

DIET

Let us know about your pet's diet so we can assess their dietary needs.

 

LIFESTYLE

Please answer to the best of your ability.

Where does your pet reside? *


Was your pet on Tick and/or Heartworm preventatives last year? *



We've done your homework for you! Due to its excellent safety profile, broad spectrum coverage, palatability and 100% guarantee our team of Veterinarians has made the decision to recommend and prescribe the Nexgard family of products (Nexgard, Nexgard Spectra, and Hartgard) this Tick and Heartworm Season. If your pet was using a different preventative product in previous years our team would be happy to answer any questions you might have at the time of your appointment.

 

Do you travel with your pet (ie. camping, etc.) or go to dog parks, doggy daycare, or boarding? *

Do you brush your pet's teeth or use dental care chews or products? *

Have you noticed any behaviour changes? *

CONSENT FOR COMMUNICATION & MEDIA USE

The Canadian Anti-Spam Legislation (“CASL”) prohibits the sending of any electronic messages that are commercial in nature unless the sender has received the recipients' express consent prior to sending the message. Our practice therefore requires your written consent to send you any electronic messages. While most of our communications are related to your pet’s health, some may contain commercial activities such as promotions, special events, or fundraising activities. Please note that if you do not consent, you will not receive ANY communications from our practice on any matter.
 

We also like to feature patients on our social media account(s), whether it be a success story, an interesting visit or the animal is just too cute not to. For us to responsibly take these videos and/or pictures we need to be granted your permission to use them on our social media account(s). Please keep in mind that your consent can be revoked at any time, but images and videos used during active consent will remain, though no further use of the images or videos will take place. A removal request can be made and will be reviewed, depending on the video and/or image we will try and remove it as requested but, in some cases, removal will not be possible, so please bear that in mind when consenting.

 

Please indicate what forms of communication are allowed: *

 

Note that phone calls must be allowed as that will always be the first contact method used in an emergency. Also, if you opt-out of email, you will not receive invoices, estimates, or reminders.

A. Service Communications
(These are used for appointment reminders, updates about your pet’s care, or billing-related matters.)
 

Print
Email
SMS/Text
Phone Calls


B. Marketing & Promotional Communications
(These are optional and include educational materials, newsletters, promotions, and social media use.)
 

Newsletter
Use of Pictures/Videos
Security Question *