New Client Registration — WetCoast Pet Care

About You

Full Name

Phone Number

Email Address

Home Address

City / Neighbourhood

Postal Code

How did you hear about us?

Emergency Contact Name

Emergency Contact Phone

Relationship to You

Pet 1 — Name

Pet 1 — Species

Pet 1 — DOB / Age

Pet 2 — Name

Pet 2 — Species

Pet 2 — DOB / Age

Additional Pets (names & species)

Which services are you interested in?

Preferred First Appointment Date

Preferred Time of Day

Vet / Clinic Name

Vet Phone

Anything else you'd like us to know

Print Name

Date

Signature (type your full name to confirm)