If you are a new client to Village Vet, please enter your details below. This also applies if you have made your first online booking as a new client. Village Vet London practice (Please select one)*Select oneBrackenburyBrook GreenChiswickEalingFinchleyGarden SuburbHampsteadHighburyHighgateKensal GreenMaida ValePalmers GreenPrimrose HillQueensparkSt Johns WoodSt HelensSouthgateWest HampsteadWinchmore HillTitle* Name* First Last Address* Street Address Address Line 2 City County / State / Region ZIP / Postal Code Phone*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 Name Pet Species*CatDogHamsterFerretRabbitGuinea PigGerbilRatMouseBirdReptileOtherPlease specify Breed* Colour* Name of previous vet (please let us know the branch name if applicable) Email or phone number of previous vet (if applicable) Pet Sex / Neutered* Female Male Female Neutered Male Neutered Has your pet been microchipped?* Yes No Not sure Pet's Date of Birth DD slash MM slash YYYY Ongoing illnesses and/or medication?Date of last vaccination DD slash MM slash YYYY Is your pet insured? Yes No Name of insurance company How did you hear about us?*Google or other search engineLocal eventMumsnetPressSocial MediaVet ReferralWalked ByWord of MouthYellow PagesOtherWould you like us to call you to make an appointment?* Yes No Village Vet is part of Linnaeus Veterinary Limited. We will not share this information with other companies for their marketing purposes. For more details on how we use your information please see our privacy policy. The personal data submitted via this form will be retained only for the purpose of responding to your question or concern, and will not be used for marketing purposes. You must be 16 years old or older to submit a form. We may use your information to send you reminders about products and services you have already purchased from us by SMS, email or post. These may be sent when your pet is due for a vaccination, flea or worming treatment or when your pet is due for a check-up recommended by your vet. If you would not like to receive these reminders please tick here We would like to send you our newsletters and contact you about promotions which may be relevant to you by post, email and SMS. If you agree to being contacted in this way please tick the relevant boxes; Email SMS Post Today's date* MM slash DD slash YYYY Please read our privacy statementCAPTCHAPhoneThis field is for validation purposes and should be left unchanged.