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New Client Form

Thank you for trusting us with your pet(s) and production animal(s).
We take this responsibility seriously and look forward to partnering with you in their care.
Please fill out this form prior to your appointment.
If you would like to speak to a member of our team or this is an emergency situation, please call us at 780-542-2144, we are here to help you!

Registration

Name of Owner *

First

Last

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Primary Phone *

Alternate Phone

Email *

Spouse/Partner

Phone

Preferred Contact Method *

Phone
Email

How did you hear about us? *

Google
Facebook
Instagram
Sign / Walked by
Referral
Other

Who referred you, we'd love to thank them!

If Other, please explain

Patient Information

Patient's Name (or list as herd, flock or appropriate group term) *

Species *

Dog
Cat
Pocket Pet/Exotic
Horse
Cow
Sheep
Goat
Other

If Other, please elaborate

Age

Date of Birth

Sex *

Female
Spayed Female
Male
Neutered Male

Breed

Colour *

List any known allergies

Other pets in the household? *

Would you like to add information for another pet? *

Patient's Name (or list as herd, flock or appropriate group term) *

Species *

Dog
Cat
Pocket Pet/Exotic
Horse
Cow
Sheep
Goat
Other

If Other, please elaborate

Age

Date of Birth

Sex *

Female
Spayed Female
Male
Neutered Male

Breed

Colour *

List any known allergies

Would you like to add information for another pet? *

Patient's Name (or list as herd, flock or appropriate group term) *

Species *

Dog
Cat
Pocket Pet/Exotic
Horse
Cow
Sheep
Goat
Other

If Other, please elaborate

Age

Date of Birth

Sex *

Female
Spayed Female
Male
Neutered Male

Breed

Colour *

List any known allergies

Please upload any of your pet's records that you may have

Click or drag files to this area to upload. You can upload up to 5 files.

Do you have pet insurance? *

If yes, please let us know which company

Former Veterinarian Name/Hospital

Former Veterinarian's Phone Number

Payment

We are happy to provide care for your animal and will review all estimated costs before proceeding with any treatment or procedure as part of our informed consent process. *

I have read and understand

Payment is accepted at the time of service unless otherwise pre-authorized through our Clinic Manager. *

I have read and understand

Please indicate your preferred payment method *

Etransfer (PW: #########)
Visa
M/C
Debit
Cash

Signature of Pet Owner *

Clear Signature

Date *

Phone

Welcome to Rocky Rapids Veterinary Services

Hours

Mon – Fri: 8:30 am – 5:30 pm
Saturday: Closed
Sunday: Closed

Visit Us

5605 56 St.
Drayton Valley, Alberta T7A 0B2
Click here for directions.

Contact Us

Phone: 780-542-2144
Fax: 780-542-6772
Email: info@rockyrapidsvet.com

Have questions?

We're here to help. Please complete the form below and a member of our team will get back to you as quickly as possible. If this is an emergency situation, please call us at 780-542-2144.

Name *

First

Last

E-mail *

Phone

Comment or Message *

Phone