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Village Veterinary Care of Merton

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Closeup of a Black Dog

Hello!

Thank you for considering becoming part of our family! Here at Village Vet Care we use a digital record keeping system. Please complete this form prior to your first appointment. Feel free to submit this form via email or print and bring it with you.

Your information will not be sold, rented or leased to a third-party.

Click here for printable version

Client Information

*required

First Name:

Last Name:

Co-Owner:

Street Address:

City:

State:

Zip code:

Primary Phone:

Secondary Phone:

Email:

How did you hear about us?

How would you like us to send future appointment reminders?

Phone Call

Text Message

Email

Pet Information

Pet 1 Name:

Pet 1 Species: *

Canine

Feline

Pet 1 Breed:

Pet 1 Color:

Female

Female-Spayed

Male

Male-Neutered

Pet 1 Birthday or Age:

Pet 2 Name:

Pet 2 Species:

Canine

Feline

Pet 2 Breed:

Pet 2 Color:

Female

Female-Spayed

Male

Male-Neutered

Pet 2 Birthday or Age:

Pet 3 Name:

Pet 3 Species:

Canine

Feline

Pet 3 Breed:

Pet 3 Color:

Female

Female-Spayed

Male

Male-Neutered

Pet 3 Birthday or Age:

I authorize Village Veterinary Care of Merton to use my pet’s photos: *

for their medical records, social media, clinic’s website, and/or in clinic use.

for their medical records only.

THANK YOU FOR REGISTERING

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