New Client Registration Form

OWNER INFORMATION

Primary Contact

First name

Last name

Email

Phone

Country/Region

Address

Address - line 2

City

Zip / Postal code

Secondary Contact (if applicable)

Would you like to add a friend or family member who can make financial and/or medical decisions on your behalf?

Yes

No

PET INFORMATION

Please note, all patients must be up to date on their rabies vaccines, confirmation of vaccine status will be requested from your regular veterinarian

First Pet

Name

Species

If you selected OTHER, please name species bellow

Breed

Colour

Sex

Reproduction Status

Birthday

Does your pet have any known illnesses?

Yes

No

If yes, please list bellow

Is your pet on any medications or supplements?

Yes

No

If yes, please list bellow

Does your pet have any allergies?

Yes

No

If yes, please list bellow

Does your pet show any behaviour concerns?

Yes

No

I don't know

Is there anything else we should know?

Second Pet (if applicable)

Do you have a second pet you wish to register?

Yes

No

Veterinary Contact Information

Which clinic is your pet(s) registered under?

Do you give permission for Paws On The Go (POTG) to administer prescription medications and/or treatment to your pet as directed by your pets DVM on your behalf?

Yes

No

Do you give permission for POTG to pick up medications and/or other pet products from your veterinary clinic on your behalf?

Yes

No

Acknowledgements and Consent

Please read and acknowledge your full understanding of the following terms by checking each box

I understand that as Registered Veterinary Technician (RVT), Chelsey Mouncey is limited within her scope of practise by law. I understand that she cannot diagnose my pet, prescribe any medication, or perform surgery of any kind.

I understand that POTG utilizes fear-free techniques, which can include the decision to stop the appointment at any time if the patient is too stressed, or if safety of any person involved is concerned as seen fit. I understand that if this should occur I am still responsible to provide payment in full for the services that were scheduled.

I understand that I am expected to restrain my own pet, and if I feel that I am unable to for any reason I agree to first make all reasonable attempts to acquire assistance from friends and/or family. If unsuccessful I acknowledge I am responsible to notify POTG as soon as possible to make other arrangements.

I understand that should I need to cancel or reschedule my pets appointment with less then 24 hours notice I may be subject to a cancelation fee of 50% total service charges.

Communication & Media Consent

I give consent to allow POTG to collect my pets patient medical history, and to forward any medical records to our regular veterinarian as seen fit or at the request of my regular DVM. This information will not be shared with anyone else.

I consent to allow POTG to capture and publish photos, audio, or video of my pet on social media or similar platforms. I acknowledge that these materials may showcase the services provided, but no private or medical details will be disclosed.

Sure!

No Thank-You

Hello! Let's get Started!

New Client Registration Form

Veterinary Contact Information

Acknowledgements and Consent

Hello!
Let's get Started!