Registering with the Elm Park Surgery

Title

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Preferred contact number

(###)

###

####

Alternative contact number

(###)

###

####

I am aware of your privacy policy

YES

Pet's name

Pet's species

Pet's breed

Age or Date of Birth

Neutered

Yes

Unknown

Sex

Male

Female

Unknown

Insurance status

Insured

Not insured

Previous vets

Please include the name of the practice and location. If this does not apply please type "none"

Anything you would like us to know?

Please fill out the form as fully as you can. It is important to give us information of any previously used vets for your pet even if they have not been there for a long time (our code of conduct requires us to do this before taking on a patient).

If you are registering more than one pet, please fill out the form as many times as needed.

Please be aware it may take up to 72 hours for your pet to be registered so if you have an urgent concern please call us and we will be happy to help. We can take more urgent registration requests over the phone.

Our privacy policy can be viewed here

We treat information sent to us sensitively and keep it confidential.

The box on the above form must be checked to show that you are aware of this policy and that you can view the policy at your convenience.