Clayton Park Veterinary Hospital
278 Lacewood Drive
Halifax, Nova Scotia B3M 3N8
Phone (902) 443-4345   Fax (902) 443-9353
Your Pets Health is Our Concern

Welcome!

Thank you for choosing Clayton Park Veterinary Hospital

In order to better serve our clients, we would like to better get to know you and your pets.  Please take a few moments to fill out our questionnaire.  Your input is very important to us.

Please Print Clearly

Name:  ________________________________________________________________________

Alternate Contact:  ______________________________________________________________  

Address: ______________________________  City/Town:  ______________________________

Postal Code:  ­_______________   Phone:    __________________________________________

In an effort to become more green we would like to begin sending our vaccine/bloodwork/annual wellness exam reminders via email. Please assist us in our efforts by providing your email address. Rest assured the we never sell or share your information.

Email: __________________________________________

Pets Name:  _                                                                  

Species:  Dog   ____    OR Cat ____     Breed (If cat, long or short hair): __________  _

Color:  ______________________        Age:  Sex Male ____   OR Female____

Spayed/Neutered:   Yes   ____    OR No ____      

Do you need files transferred from another Veterinary Hospital? :   Yes  ___    OR No ___

If yes, previous hospital name:  ________________________________________________________________

Do you have pet insurance? :   Yes   ___    OR No ___

If yes, what company are you with?  ________________________________________________________________

 

Where did you hear of our hospital?

		Friend or Relative
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