Individual Client Registration Form

Please complete the following information in order to register as a new client with the Wellington Animal Hospital Group.

* All fields are compulsory and must be completed.

Individual Client Information

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Patient Information

    Patient 1

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    1. For the safety of your pets, all animals must be under control of the owner at all times i.e. on a lead or in a travel box.
    2. Quotations supplied on request. Fees are to be settled after each consultation or at the time of discharge of hospital patients. Please discuss possible costs with the veterinarian.
    3. This is a cashed-based business. Credit will only be given after written credit application has been approved by the practise manager. A deposit will be required.. Interest and administration fees are charged on all outstanding amounts.
    4. Food and merchandise is a strict cash transaction and may not be purchased on account.
    5. Services will be refused to minors without written consent from a parent/legal guardian. Payment is as mentioned above, with the parent/legal guardian being the responsible party.
    6. As client you are responsible for informing the veterinarian of any current treatments or professional contact with another veterinary facility.
    7. Should any of your particulars change please inform the receptionist without delay using the relevant contact details for your chosen branch.
    8. The account is the responsibility of the account holder. Should you agree to assist someone else on your account, you will still be held liable for the full settlement of the account.

    Please update your information with us on a regular basis in order to facilitate effective communication. Thank you

    I understand and accept these terms and hereby give permission for services to be rendered. I also hereby indemnify all veterinarians, nurses and staff of this practise against any claim for damages whatsoever nature arising out of procedures and treatments of my pet(s) and/or animals. I accept full responsibility for costs incurred and full payment thereof.