New client registration form
Village Vet Practice *    Find your nearest practice
Title *
Forename
Surname *
Address *
 
Town/City *
County *
Postcode *
Telephone Number - Home *
Mobile Number
Email *
 
If you have several pets, please only register one initially. We will shortly be in contact with you by phone
to confirm your registration. At this point, or during your first visit, we can register your other pets.
 
Pet's Name *
Species *
Species (if other please specify)
Breed
Colour
Sex
Age Year(s)    Month(s)

Ongoing illnesses and/or
medication?
Date of last vaccination   
Has your pet been microchipped? * Yes   No   Not sure
Is your pet insured? * Yes   No
Name of Insurance Company
Is your pet currently registered with another vet? * Yes   No
If your pet is currently registered with
another vet please name the practice here

How did you hear about us?
(please include search engine if used internet)
Would you like us to call you
to make an appointment?		 * Yes   No
Would you like to join
our loyalty scheme?		 * Yes   No
I am happy to receive information related to Pet Health, Pet Health Services provided by Village Vet and current promotions being offered by Village Vet by e-mail: * Yes
No
When receiving reminders for Preventative Healthcare treatments (e.g. vaccination, worming etc.), would you prefer to receive Notification by (you may tick more than one box) * E-mail
Mail
Text
Phone Call
No Preference

Village Vet offers Total Care Pet Insurance for cats and dogs which includes a Preventative Healthcare Package.
Tick here if you are interested in receiving a call
to learn more and obtain a quote.
 
Data protection:

Village Vet will use the personal information you give us exclusively for the purposes of caring for your pet and providing you with information related to care of your pet and Village Vet services where this has been requested. We will Not pass on any of your details to outside organisations or individuals except with your express consent.