New Clients - Intake Form

Welcome to Speers Road Animal Hospital — a locally owned Canadian veterinary clinic proud to serve our community.

We are now open and currently accepting new patients. We are open late and on weekends.

Please fill out the information below so our team can book your pet’s appointment.

Once you submit the form, we will contact you as soon as possible. Please allow up to 1 business day for a response.

Owner Information:

Full Name

Phone Number *

Email *

Patient Information:

Pet Name

Pet Weight

Pet Species

Pet Breed *

Is Your Pet Fixed?

Sex *

Male

Female

Consent

I the undersigned, do hereby certify that I am the owner of the above animal or duly authorized agent for the above animal. I hereby authorize Speers Road Animal Hospital, their agent or representative to perform medical or surgical procedures, anesthesia, radiographic procedures, administration of drugs or other such treatments which the veterinarian deems necessary. I agree to accept responsibility for the full payment of all services rendered at each visit. I hereby state that I have read this release and I understand this agreement. *

I understand and agree.

I Consent to Receive SMS Notifications, Alerts & Upcoming Appointment Details from ALASHRAF VETERINARY MEDICINE PROFESSIONAL CORPORATION as (d.b.a) Speers Road Animal Hospital. Message frequency may vary. Message & data rates may apply. Text HELP for assistance. You can STOP to unsubscribe at any time.

I Consent to Receive the Occasional Marketing Messages from ALASHRAF VETERINARY MEDICINE PROFESSIONAL CORPORATION doing business as (d.b.a) Speers Road Animal Hospital . You Can Reply Stop to unsubscribe at any time.

Signature *

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