New Client Application

New Client Application Form

Welcome

Please read our following terms of engagement.

If you agree and would like to apply to register as a client of Central Hutt Vets,
please fill in the following form and add the pets that you would like treated.

Central Hutt Vets - Terms of Engagement

As a client of Central Hutt Vet Clinic, I understand that:

annual vaccinations and check-ups are critical to providing my pet with preventative care and for detecting developing health conditions.
dental care and maintenance, including periodic dental cleaning under anaesthetic, is a very important part of my animal's overall health and comfort.
having a pet may sometimes result in unanticipated expenses, and that Central Hutt Vets recommend that I arrange pet insurance, access to savings, or finance options to ensure I can provide care for my pet if needed.
payment is required at the time of service being provided. Central Hutt Vets accept Mastercard, Visa, and Amex and Afterpay. Unpaid bills may be sent to debt collection and have debt collection fees added.
the clinic can be very busy and appointment slots are in demand. To keep consultations running on schedule, it is important to arrive for appointments on time, although emergency cases may take priority. Central Hutt Vets reserves the right to charge for missed appointments that were not notified in advance.

If you agree, please proceed filling out the following form adding all necessary pets

Caution: Don't use your Browser Back button while filling out the form or your may lose your data, instead use the buttons provided to navigate back and forward.

* please complete mandatory fields, thank you

New Client Details

Firstname of primary owner

Lastname of primary owner

Title of primary owner

Firstname of secondary owner

Lastname of secondary owner

Title of secondary owner

Street number and name

Suburb or Town

Postal Address (if different)

Email address

Mobile phone number

Home phone number

Alternate Phone (e.g. secondary contact)

Pet Details

Pet's Name

Type (dog / cat / rabbit / bird / etc.)

Main breed

Cross breed (if any)

Colour (animal-specific terms such as tabby, brindle, etc.)

Age / DOB

Sex Male Female

Desexed? Desexed Not Desexed

Date of most recent vaccination (if known)

Is Pet up to date with worm and flea treatments? (add name of products used if known)

Is Pet insured? Insured Not Insured

Is Pet transferring to us from a previous clinic? Transferring Not Transferring

If transferring, I consent for my pet’s medical notes to be requested by Central Hutt Vets: I Consent I do not Consent

Name of previous clinic (if applicable)

Does your pet have any known health conditions and/or current medications?

Pet Two Details

Pet's Name *

Type (dog / cat / rabbit / bird / etc.) *

Breed

Cross breed (if any)

Colour (animal-specific terms such as tabby, brindle, etc.)

Age / DOB *

Sex * Male Female

Desexed? * Desexed Not Desexed

Date of most recent vaccination (if known)

Is Pet up to date with worm and flea treatments? (add name of products used if known)

Is Pet insured? * Insured Not Insured

Is Pet transferring to us from a previous clinic? Transferring Not Transferring

If transferring, I consent for my pet’s medical notes to be requested by Central Hutt Vets: I Consent I do not Consent

Name of previous clinic (if applicable)

Does your pet have any known health conditions and/or current medications?

Pet Three Details

Pet's Name *

Type (dog / cat / rabbit / bird / etc.) *

Breed

Cross breed (if any)

Colour (animal-specific terms such as tabby, brindle, etc.)

Age / DOB *

Sex * Male Female

Desexed? * Desexed Not Desexed

Date of most recent vaccination (if known)

Is Pet up to date with worm and flea treatments? (add name of products used if known)

Is Pet insured? * Insured Not Insured

Is Pet transferring to us from a previous clinic? Transferring Not Transferring

If transferring, I consent for my pet’s medical notes to be requested by Central Hutt Vets: I Consent I do not Consent

Name of previous clinic (if applicable)

Does your pet have any known health conditions and/or current medications?

Pet Four Details

Pet's Name *

Type (dog / cat / rabbit / bird / etc.) *

Breed

Cross breed (if any)

Colour (animal-specific terms such as tabby, brindle, etc.)

Age / DOB *

Sex * Male Female

Desexed? * Desexed Not Desexed

Date of most recent vaccination (if known)

Is Pet up to date with worm and flea treatments? (add name of products used if known)

Is Pet insured? * Insured Not Insured

Is Pet transferring to us from a previous clinic? Transferring Not Transferring

If transferring, I consent for my pet’s medical notes to be requested by Central Hutt Vets: I Consent I do not Consent

Name of previous clinic (if applicable)

Does your pet have any known health conditions and/or current medications?

I have more than four pets, I understand that CHV will contact me about my additional pets

Firstname

Email address

Mobile phone number

Any general comments that you would like to let us know about?

Send me a copy of this form

Thank you

We will be in touch soon.

Our Details