New Patient Form | PEI Veterinary Walk-in & Urgent Care

Great news, pet parents! Flexible Payment Plans Available: Care Now, Pay Later

902-332-1808

58 Macleod Cres a, Charlottetown, PE C1E 3K2, Canada

Book an Appointment

902-332-1808

Book an Appointment

About Us
- What to Expect
Our Team
Services
For Referring Vets
Contact Us

New Patient Form

Please complete the form below as fully as possible prior to pet’s first appointment which will help expedite the registration process and give us valuable insight in providing the best possible care for a pet.

Owner’s First Name*

Owner’s Last Name*

Co-Owner’s First Name*

Co-Owner’s Last Name*

Phone number

Street Address*

Address Line 2

State / Province / Region*

City*

ZIP / Postal Code*

Country*

Mobile number

Email*

How did you find out about our practice?*

Clinic Location
Personal Referral
Internet Search/Website

Yellow Pages
Clinic-Sign
Newspaper / Print Media

Other

If Other, please specify:

If Personal Referral, is there someone we can thank for this referral?

Pet’s Name*

Species*

Breed (if known)

or if other species

Color

Date of Birth or Age (if known)

Special Identification (tattoo, microchip, etc.)

Sex*

Previous Veterinary Practice (if any)

Previous Veterinarian (if any)

Date of last vaccines (if known)

What vaccines were given at this time

Is your pet on any medication or supplement?

If Yes, please list the medication or supplement

What food does your pet eat?

Does your pet have allergies or drug reactions?

If Yes, please list the allergies and reactions

Are there any current or past medical conditions of which we should be aware?

If Yes, please comment on the condition(s) and indicate if they are current or past conditions

Please use the following box to give us any other relevant information about your pet

58 Macleod Cres a, Charlottetown, PE C1E 3K2, Canada

902-332-1808

info@peiurgentcare.ca

About clinic

About Us
What to Expect
FAQ
Our Team
Payment Plans

Our services

Emergency Care
Surgical Interventions
Poison Control

Forms

How We Work
Patient Form

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