AFTER-HOURS 613-634-2440
Sims Animal Hospital 613-531-3334

New Client Registration

New Client Registration

If you are a new client please complete the form below in full.
 

If you have any questions, feel free to contact the clinic at 613-531-3334 to speak with a member of our team.

 

CLIENT INFORMATION

PATIENT INFORMATION

PATIENT INTAKE QUESTIONNAIRE

Has there been any vomiting? *

Has there been any diarrhea? *

Has there been any changes in appetite? *

Has there been any changes in thirst? *

Has there been any changes in urination frequency? *

Are there any concerns with mobility? *

Is your pet on any medications? *

Flea/tick/heartworm medications:




Has there been any tick exposure? *

CONSENT FOR COMMUNICATION & MEDIA USE

The Canadian Anti-Spam Legislation (“CASL”) prohibits the sending of any electronic messages that are commercial in nature unless the sender has received the recipients' express consent prior to sending the message. Our practice therefore requires your written consent to send you any electronic messages. While most of our communications are related to your pet’s health, some may contain commercial activities such as promotions, special events, or fundraising activities. Please note that if you do not consent, you will not receive ANY communications from our practice on any matter.
 

We also like to feature patients on our social media account(s), whether it be a success story, an interesting visit or the animal is just too cute not to. For us to responsibly take these videos and/or pictures we need to be granted your permission to use them on our social media account(s). Please keep in mind that your consent can be revoked at any time, but images and videos used during active consent will remain, though no further use of the images or videos will take place. A removal request can be made and will be reviewed, depending on the video and/or image we will try and remove it as requested but, in some cases, removal will not be possible, so please bear that in mind when consenting.

 

Please indicate what forms of communication are allowed: *

 

Note that phone calls must be allowed as that will always be the first contact method used in an emergency. Also, if you opt-out of email, you will not receive invoices, estimates, or reminders.

A. Service Communications
(These are used for appointment reminders, updates about your pet’s care, or billing-related matters.)
 

Print
Email
SMS/Text
Phone Calls


B. Marketing & Promotional Communications
(These are optional and include educational materials, newsletters, promotions, and social media use.)
 

Newsletter
Use of Pictures/Videos
Security Question *