New Client Registration

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New Client Registration Form

Thank you for considering our hospital as your pet’s provider of veterinary services. We are dedicated to maintaining the health of your pet and look forward to many future years together.

Please complete this form as fully as possible prior to your first appointment which will help expedite the registration process and give us valuable insight in providing optimal care for your pet(s). The required sections have a red * asterisk.

Owner's Name
Name*
First Last
Address*
Street Address Address Line 2 City ZIP / Postal Code
Day-Time Phone*
Evening Phone
Mobile Phone
Email*
Enter Email Confirm Email
Co-owner's Name & Contact #
Name
First Last
Phone
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?
Please use this area to give us any other relevant information about yourself or your family
Pet Information
Pet's Name*
Species*
or if other species
Breed (if known)
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)
Date Format: MM slash DD slash YYYY
What vaccines were given at this time
Is your pet on any medication or supplement?
- Yes
- No
If Yes, please list the medication or supplement
What food does your pet eat?
Does your pet have allergies or drug reactions?
- Yes
- No
If Yes, please list the allergies and reactions
Are there any current or past medical conditions of which we should be aware?
- Yes
- No
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

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New Client Registration
Prescription Refill and Food Order Request Form

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Merivale Papanui Veterinary Clinic
375 Papanui Road
Merivale, Christchurch 8052

Phone: 03 3529279
Email: admin@merivalepapanuivets.com

For all emergencies when we are not open please contact the 'After Hours Veterinary Clinic' on 033661052, cnr of Antigua and Disraeli streets, Christchurch.

Clinic Hours

Monday	8:00am – 7:00pm
Tuesday	8:00am – 7:00pm
Wednesday	8:00am – 7:00pm
Thursday	8:00am – 7:00pm
Friday	8:00am – 7:00pm
Saturday	8:00am – 12:30pm
Sunday	Closed

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New Client Registration