New Client Form

New Client Intake Form

Welcome and thank you for your interest in receiving pet care at Kitsilano Animal Clinic.
The information in this form will help us create your profile and identify your current concerns. We
will follow up within 48 hours to schedule your first visit.

If this is an emergency, call(604) 736-8648for direct assistance.

Owner Information

Full Name(Required)

Co-Owner Full Name

Phone(Required)

Email(Required)

How did you hear about us?(Required)

Name Of Previous Animal Clinic(Required)

For any file transfers

Address(Required)

Street Address Address Line 2 City Province Postal Code

Pet Information

Pet's Name(Required)

Breed

Species(Required)

Colour

Sex

Date of birth/Age

Date of last vaccines (if applicable)

What vaccines were given? (if applicable)

Is your pet on any medication or supplements?

Does your pet have/had a medical condition?

What food (brand) does your pet eat?

Does your pet have any allergies or drug reactions?

Additional notes about your pet

Consent Signature (Your Name)

If you give consent to the above, please provide your name and pet’s name so that we can appropriately credit you and your pet!

Consent Signature: Pet's Name