Thank you for choosing
Harbour Cities Veterinary Hospital
In order to better serve our clients, we would like to better get to know you and your pets. Please take a few moments to fill out our questionnaire. Your input is very important to us.
Please Print Clearly
Name: ________________________________________________________________________
Alternate Contact:
______________________________________________________________
Address: City/Town: ____________________________________________________________
Postal Code: _______________ Phone: __________________________________________
Pets Name: _ _
Species: Dog ____ OR Cat ____ Breed (If cat, long or short hair): ______________ _____
Color: ______________________ Age: Sex Male ____ OR Female____
Spayed/Neutered: Yes ____ OR No ____
Do you need files transferred from another Veterinary Hospital? : Yes ____ OR No ____
Hospital Name: ________________________________________________________________
______________________________________________________________________
_______
Address: ___________________________ _____________________________________
______________________________________________________________________
_______
Comments: ____________________________________________ ____________________
______________________________________________________________________
_______
Where did you hear of our hospital?
|
|
|
Friend or Relative |
|
|
|
Advertising |
|
|
|
Yellow Pages |
|
|
|
Web |
|
|
|
Other |