New Registration: Individual

  • SHOULD ANY OF YOUR CONTACT DETAILS CHANGE, YOU ARE TO PLEASE INFORM RECEPTION IMMEDIATELY

  • YOUR ACCOUNT REMAINS YOUR RESPONSIBILITY - EVEN IN THE EVENT YOU AGREE TO HELP SOMEONE ELSE USING YOUR ACCOUNT.

Person Responsible for the Account

Alternative Contact Person

Patient(s) Information

Patient 1

Patient 2

Terms and Conditions

Disclosure of Your Personal Data

Confirmation of Consent: Person Responsible for the Account

Thank you for your registration! Your information has been submitted to Wellington Animal Hospital for filing. If you have any questions regarding this application, please feel free to contact us at [email protected].
Something went wrong while submitting the form. Please try again, but if the problem persists, please feel free to contact us at [email protected] for a digital PDF or paper application.