REGISTER

Online

Are you an existing client of Cedar Palm Vets with a pet already registered? (Y/N) *

Title: *

Name: *

Surname: *

Address: *

Post Code: *

E-mail address: *

Mobile Number: *

Home Number:

Work Number:

How many pets do you want to register? *

First Pet

Name: *

DOB: *

Species: *

Breed: *

Colour: *

Chipped (Y/N): *

Sex: *

Is Pet Insured? (Y/N): *

Insurance Company:

Policy Number:

Second Pet

Name: *

DOB: *

Species: *

Breed: *

Colour: *

Chipped (Y/N): *

Sex: *

Is Pet Insured? (Y/N): *

Insurance Company:

Policy Number:

Third Pet

Name: *

DOB: *

Species: *

Breed: *

Colour: *

Chipped (Y/N): *

Sex: *

Is Pet Insured? (Y/N): *

Insurance Company:

Policy Number:

Fourth Pet

Name: *

DOB: *

Species: *

Breed: *

Colour: *

Chipped (Y/N): *

Sex: *

Is Pet Insured? (Y/N): *

Insurance Company:

Policy Number:

Fifth Pet

Name: *

DOB: *

Species: *

Breed: *

Colour: *

Chipped (Y/N): *

Sex: *

Is Pet Insured? (Y/N): *

Insurance Company:

Policy Number:

Sixth Pet

Name: *

DOB: *

Species: *

Breed: *

Colour: *

Chipped (Y/N): *

Sex: *

Is Pet Insured? (Y/N): *

Insurance Company:

Policy Number:

Seventh Pet

Name: *

DOB: *

Species: *

Breed: *

Colour: *

Chipped (Y/N): *

Sex: *

Is Pet Insured? (Y/N): *

Insurance Company:

Policy Number:

Eighth Pet

Name: *

DOB: *

Species: *

Breed: *

Colour: *

Chipped (Y/N): *

Sex: *

Is Pet Insured? (Y/N): *

Insurance Company:

Policy Number:

Ninth Pet

Name: *

DOB: *

Species: *

Breed: *

Colour: *

Chipped (Y/N): *

Sex: *

Is Pet Insured? (Y/N): *

Insurance Company:

Policy Number:

Tenth Pet

Name: *

DOB: *

Species: *

Breed: *

Colour: *

Chipped (Y/N): *

Sex: *

Is Pet Insured? (Y/N): *

Insurance Company:

Policy Number:

Would you like a member of our staff to call you?: *

Name of Previous Vet:

Previous Vet Name: *

Previous Vet Postcode: *

Previous Vet Address: *

Previous Vet Email: *

Is a routine Vet appointment required? (Y/N): *

Most convenient time to telephone you? *

Any questions/concerns?

Optional

Please attach a scan of any documents which may assist our vets in providing the very best care e.g. medical history, pet insurance documents, pet vaccination cards, microchip documentation. (max upload 3MB)

I confirm that I am the registered owner of the named animal(s) above. Once submitted our team will shortly be in touch to confirm registration and make any routine appointments with you. Welcome to Cedar Palm Vets!

By selecting this box you confirm that you give permission for Cedar Palm Vets to use your email address to contact you for important information such as vaccination and healthcare reminders relating to your pet and practice information updates.

You give permission for Cedar Palm Vets to use your email address for marketing purposes such as receiving our newsletter and offers relevant to your pet. (Y/N): *YesNo

I give permission to request medical history from previous vet

I have read and agree with the Privacy Policy (GDPR)Please leave this field empty.

Register Your Pet Online

If you have an urgent enquiry or an emergency then please do not fill in this form and instead call us on 07415 436 781

Please fill in the form below and you will receive a confirmation e-mail once you are successfully registered. From this point on you will be able to make online bookings for us to see your pet. Please bear in mind that we will need to see your pet before being able to dispense any medication (including flea/worm treatment)

REGISTER

Online

Register Your Pet Online

Care, Compassion & Competence

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