New Client Form

Bedford Highway Veterinary Hospital

936 Bedford Highway
Bedford, NS B4A 3P1

(902)835-2323

www.bedfordvet.com

New Clients

Welcome!  We are always accepting new clients.  To help us get to know you and your pet better, please fill out the form below or right click on the link below to save our new client form.  You can either email the form to us at bhvh@eastlink.ca or print it off and bring it in.  If you are unable to do so, we would be pleased to provide you with the form when you come in for your appointment.  Depending on the reason for your visit, there may be other paperwork we might ask you to complete to help us help your pet.  Thanks!

(Please right click and save this form to your computer)

New Client Form

New Client Form Form

Date :
Your Name (required)
First Name (required)
Last Name (required)
Spouse/Other
First Name
Last Name
Address (required)
Street Address (required)
City (required)
,
State / Province (required)
Zip / Postal Code (required)
Home Phone (required)
Phone TypePhone Number (required)
Work Phone
Phone TypePhone Number
Cell Phone
Phone TypePhone Number
Spouse's Phone
Phone TypePhone Number
E-Mail Address (We require client consent, valid for 2 years, in order to send informative email): (required) :
Pet Name (required)
First Name (required)
Last Name (required)
Dog, Cat, or Other? (required)

Breed: (Ex. Short/Long Haired? Siamese? (required)

Age/Birth date: (required)

Sex: (required)

Spayed/Neutered? (required)

Colour;

How did you learn of our hospital?

Friend/Relative that we may thank for your referral?
Yellow Pages phone book
Yellowpages.ca
Signage
Google
Other


Is your pet microchipped? :
Do you need files transferred from another hospital? If yes, please specify: (required)

PLEASE NOTE: All professional fees are due at the time services are rendered. We accept CASH, DEBIT, VISA, MASTERCARD, and AMERICAN EXPRESS. Sorry, we do not accept cheques.

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