Client Registration Form and Privacy Policy

Thank you for considering our hospital as your pet’s provider of veterinary services. We are dedicated to maintaining the health of your pet and look forward to many future years together.

Please complete this form as fully as possible prior to your first appointment which will help expedite the registration process and give us valuable insight in providing optimal care for your pet(s). The required sections have a red * asterisk.

At Millwoods East Veterinary Clinic we respect your right to privacy and will not collect, use, or disclose any personal information regarding you or your pet without your consent. The information we seek from you is obtained so that we can provide high quality veterinary service and ensure that you are fully aware of our actions. In all cases, we will only disclose personal information about you in circumstances where we believe that it will be beneficial to the continued good health of your pet.

Owner's Name
Name*
First Last
Primary owner. This is the person most likely to bring the pet into the clinic, and also the main contact.
Address
Address*
Street Address Address Line 2 City Province Postal Code
Preferred Phone*
Please tell us which number to call you at first
What type of number is this?*
Secondary Phone
Please tell us which number to call you at if we can't reach you at your preferred number
What type of number is this?
Co-owner's Name & Contact #
Name
First Last
Cell Phone
Work Phone
Receiving Reminders and Newsletters*
Do you consent to receiving emailed vaccination and/or medication reminders, and a clinic newsletter (once every few months)?

If you choose NOT to receive emailed reminders, you will receive a postcard in the mail instead.
- Yes
- No
Do you consent to receive email and/or text reminders?*
Do you consent to receive email and/or text reminders?
- Yes, email and text are ok
- I prefer texts, no emails
- I prefer emails, no texts
- I prefer mail or phone call reminders. No texts or emails
Email*
Enter Email Confirm Email
How did you find out about our practice?
- Clinic Location
- Personal Referral
- Internet Search / Website
- Clinic Sign
- Other
If Other, please specify:
Pet Information
Pet's Name*
Species*
Breed (if known)
Color
Date of Birth or Age (if known)
Special Identification
Tattoo or microchip number
Sex
Photos of your pet*
We love your pet, and from time to time we may take photos and post them on our Facebook and Instagram pages. We will not include any owner information. Is it OK to take photos of your pet and post them on social media?
- Yes
- No
Privacy Policy
Please read our privacy policy below.*
Situations where the collected information may be used internally by staff of Millwoods East Veterinary Clinic Ltd:
1. To contact you regarding the results of tests, further treatment recommendations, or the progress of recovery.
2. To remind you either by telephone, mail or email that vaccination boosters or other preventative treatments, laboratory tests or medications are due.
3. For billing purposes.

Situations where the collected information may be used externally and disclosed to a third party:
1. To a pet insurance company, when the company requests a medical file for a claim.
2. To provide your name, address, and telephone number to the Edmonton Animal Care and Control or the Edmonton Humane Society if they have recovered your lost pet, or to provide your phone number to an individual that has found your pet and we have traced your information through a Rabies tag from our clinic.
3. If your pet is injured when you are not present and it is taken to another veterinary clinic for emergency care.
4. If blood results, and/or radiographs are requested by a referred veterinary clinic for diagnostic testing, treatment, or surgery.
5. If you have requested your file and pet’s medical records sent to another clinic.
6. Microchip or Tattoo registration.
I agree to the privacy policy and allow Millwoods East Veterinary Clinic to use my information ONLY in the situations outlined above:
No-Show Policy
Please read our No-Show Policy below:*
In order to offer appointments to all of our patients, we have a No-Show Policy. If you cannot make it to your appointment, please call us in advance to notify us. If you do not show up for your appointment and do not notify us in advance, a $50 fee will be charged to your account, to be paid prior to your next appointment.
I agree to the privacy policy.

Client Registration Form and Privacy Policy

Owner's Name

Address

Co-owner's Name & Contact #

Pet Information

Privacy Policy

No-Show Policy

Address

Contacts

Hours