Client Name (Owner) *

First Name

Last Name

Additional owner/Decision maker

First Name

Last Name

Cell Phone *

(###)

###

####

Additional Phone number (If applicable)

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Spayed/Neutered? *

Yes

No

Date of Birth *

MM

DD

YYYY

I give permission to Millcreek Veterinary Clinic to send emails and/or text messages regarding upcoming appointments as well as messages pertinent to my pet's general health or wellbeing *

Yes

I give permission to Millcreek Veterinary Clinic to take photos of my pet during appointments for use on the clinic website and social media accounts (no personal information other than your pet’s name will ever be shared). *

Yes

No

Terms of Service *

Please view our terms of service using the link below, or visit : www.millcreekvetclinic.ca/terms-of-service

I agree to the Terms of Service