New Patient Registration

Informed Consent for Email Contact:

By providing my email address below, I am agreeing that Quinte Animal Hospital employees are permitted to send emails to the below address in regards to my pets.


I can opt out of receiving emails at any time by contacting the hospital by phone or email. This email address may be used in correspondence relating to pet health insurance, news, updates etc.



Valid ID will be required for military discount


Emergency Contact

Patient Information

DogCat







MaleFemale
YesNo



This information is obtained in confidence and is intended for use only by Quinte Animal Hospital. Any other distribution, copying or disclosure is strictly prohibited. The contents of this document may also be subject to privilege and all rights to that privilege are expressly claimed and not waived.

Photo Release

YesNo

By submitting this New Clients Form, I agree that I am the legal owner of the pet(s) listed above and that all information is true.