client registration form

Welcome to our WILD family!

To prepare for your visit, please fill in the Client Registration Form below:

Primary Contact Details (Must Be Over 18)

Title *

Name *

First

Last

Mobile Phone *

Email *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Age Group *

How did you hear about us? *

Secondary Contact Details

Title

Name

First

Last

Mobile Phone

Pet Details

Pet's Name

Species

Breed

Communication Preferences

Select if you would like to opt out of any communication *

Deposit

Group did about

To reserve your appointment spot, we require a security deposit. In the event that you do not show up, or cancel/reschedule within 6 hours of the appointment, this deposit will be forfeited. Please note that the remainder of the bill (if applicable) is to be paid at the end of the consultation. For a breakdown of our fees, please refer to our Price List.

Consultation Deposit

Price: $120.00

Stripe Credit Card Authorisation *

Terms & Conditions

By signing this form, I declare that:

I am over 18 years of age
I am the legal owner of the pets listed above
I have read and understood The Wild Vet's Terms of Service
I authorise The Wild Vet staff to examine and treat my pet(s)
I understand that a minimum of six (6) hours notice is required to modify any scheduled consultations, and a minimum of forty-eight (48) hours notice is required to modify any scheduled procedures.

Signature

Clear Signature

THE WILD VET

Client Registration Form