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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 practice (Please select one)*

Title*

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / 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*

Please 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

Ongoing illnesses and/or medication?

Date of last vaccination

Is your pet insured?

Yes
No

Name of insurance company

How did you hear about us?*

Would 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;

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SMS
Post

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