Thank you for giving us the opportunity to care for your pet. Please help us meet your needs by taking a moment to share some important information we will need to support your pet’s health today and in the future.
Please fill in all the below information for the primary account holder (person who will be primarily bringing your pet(s) in to see us and is authorized to make decisions regarding patient care):
(If you choose no, we will wait to hear from you to schedule an appointment)
*By providing an email address and cell phone above, you consent to having your email and cell phone used for communication purposes – such as communication about your pet, reminders, newsletters, receipts, estimates and appointment reminders.
Relationship to primary account holder:
Authorized to make decisions regarding patient care:
How did you find us or hear about us?
Date & Location of last vaccinations:
Does your pet have a tattoo or microchip?
Are there any medical concerns that we should be aware of?
*We will gladly prepare a written estimate if you desire (please ask our doctor or receptionist). We accept Cash, Debit, Visa and Mastercard. No personal cheques please.
Landing Animal Clinic complies with the Personal Information Protection Act, which came into effect in Alberta on January 1, 2004. We are committed to respecting the privacy rights of all of our clients by ensuring their information is collected, used, and disclosed in an appropriate manner.
Consent to Collect, Use, and Disclose Personal Information
I, , authorize Landing Animal Clinic to collect, use, and disclose my personal information for the following purposes:
I understand that I may decline or object to having my personal information collected, used, or disclosed for the above purposes. I also understand that I may revoke this consent at any time by submitting a written notice.
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