Call Us Today! 306-477-1222

New Patient Intake Form

Please complete the form below as accurately as possible. Once we receive the completed form, an administrator will use the information you provided to create a patient file for your pet. Filling out this form ahead of time will speed up the registration process when you arrive for your first appointment.





Owner/Caregiver
First Name:*
Last Name:*
Street Address
Street Address*
City*
State / Province / Region*
ZIP / Postal Code:*
Home Phone:*
Alternate Phone:
Email: *
Pet Information

Please answer the following questions to the best of your knowledge. If you are unsure of any specifications such as breed or date of birth, simply type ‘unknown’ in the answer field.

Pet’s Name:*
Species: *
Breed:*
Color/Markings: *
Gender:*
Neutered/Spayed? *
Age/Birthdate:*
Are Vaccinations Current?*
How did you hear about us?
Name of Referee or Source of Referral:*

(So that we know who to thank! Ex: Name of friend or family member, rescue group or humane society, Google, Facebook, Yellow Pages, etc. )

Details:
Statement of Ownership

By checking below you certify that you are the owner and or agent of the above animal and have the authorization to consent to treatment if and when it is needed.

Confirmation*

I Agree

Financial Policy

Acadia Veterinary Clinic requires payment in full for professional services rendered at the time of discharge from the clinic. Our practice accepts the following methods of payment: Cash, Debit, Visa and MasterCard. As legal owner or responsible agent for the above animal, I certify that I have read and agreed the above financial policy and therein assume financial responsibility for all services rendered.

Confirmation*

I Agree

Comments (optional):

Check to confirm submission

#4-3421 8th Street East
Saskatoon, SK S7H 0W5
(306) 477-1222

Opening Hours:
Mon-Fri 7:30am-6pm
Saturday 8:30am- 3pm



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