Resources

Forms

By completing our new client form you can save sometime during the check in process. Payment for services may be paid by cash, interac, Visa, MasterCard, or American Express upon receipt of services. Cheques are not accepted at our hospital.

 

New Client Form

Complete the new client form below or click here to download.

OWNER INFORMATION
Owner *
Owner
Spouse/Other
Spouse/Other
Owner's Address *
Owner's Address
Owner's Phone *
Owner's Phone
Owner's Alternate Phone
Owner's Alternate Phone
Spouse/Other's Phone
Spouse/Other's Phone
Spouse/Other's Alternate Phone
Spouse/Other's Alternate Phone
Preferred method of contact for annual reminders? *
I'd like to join the email mailing list to receive appointment reminders, news and clinic promotions. *
Alternate Emergency Contact
Alternate Emergency Contact
Emergency Contact's Phone
Emergency Contact's Phone
Do you currently have, or are interested in pet insurance?
PET INFORMATION
Pet 1
Birthdate
Birthdate
Date of Last Vaccine
Date of Last Vaccine
Pet 2
Birthdate
Birthdate
Date of Last Vaccine
Date of Last Vaccine
Pet 3
Birthdate
Birthdate
Date of Last Vaccine
Date of Last Vaccine
 

Alternative Therapy Referral Form

NOTE: All referrals require medical records be faxed or emailed to Town Centre Veterinary Hospital prior to the client’s first appointment.

F: 780.461.4775 | E: pet.care@towncentrevet.ca

All Acupuncture referrals require a complete physical examination prior to the first acupuncture treatment. X-rays, blood work, or other diagnostic tests may be required depending on the condition being treated and on what has already been performed at the referring clinic. Please fax all results prior to the client’s first visit.

All chiropractic/manual therapy referrals will require a complete physical examination and possibly x-rays at TCVH prior to the first chiropractic assessment. If x-rays have already been taken at your hospital, please send them with your client or email so we can review them at or prior to the initial assessment.

All massage therapy referrals will require a physical examination at TCVH prior to the first massage session, but x-rays are not necessary.


Complete the alternate therapy referral form below or click here to download.

REFERRAL INFORMATION
OWNER INFORMATION
Name *
Name
Address *
Address
Phone *
Phone
Alternate Phone
Alternate Phone
PET INFORMATION
Birthdate
Birthdate
Requested Treatment
 

Perscription Refill Request Form

Complete the prescription refill request form below or click here to download.

Owner's Name *
Owner's Name
Phone *
Phone
Alternate Phone
Alternate Phone
Last Dispensed
Last Dispensed
 

Client Satisfaction Survey

Thank-you for taking the time to complete our client satisfaction survey. Your opinion is important to us. The information you provide will help us to improve our services. Please note all fields are optional and your answers will remain confidential.

GENERAL INFORMATION
Owner's Name
Owner's Name
Date of Last Visit
Date of Last Visit
QUESTIONS
1.
Was the hospital clean and odor-free?
2.
2.
Were you promptly greeted by the receptionist?
Did the receptionist seem friendly?
Was the receptionist helpful?
Was the receptionist efficient at check-in?
Was the receptionist efficient at check-out?
3.
Was the waiting time short and acceptable?
Was it an emergency situation?
4.
Was the examination of your pet thorough and complete?
5.
5.
Was the veterinarian pleasant and professional?
Did the veterinarian explain things clearly?
Was the veterinarian kind to my pet?
Did the veterinarian provide excellent medical care?
6.
6.
Were the technicians pleasant and professional?
Were the technicians kind to my pet?
Did the technician provide excellent medical care?
Were the technicians helpful and competent?
7.
Were our hours convenient?
8.
Do you feel well-informed about the services and products we offer?
9.
Do you find our website useful and informative?
Do you find our website easy to navigate?
Do you find our website easy to find with search engines?
10.
10.
Was your overall experience positive?
11.
11.
Would you recommend Town Centre Veterinary Hospital to friends and family?
12.
 

Blood Glucose Curve Form

Complete the blood glucose curve form below or click here to download.

GENERAL INFORMATION
Name *
Name
PET'S BACKGROUND
Date of Curve
Date of Curve
Time of Insulin Administration:
Time of Insulin Administration:
FINDINGS
Result 1
Time
Time
Result 2
Time
Time
Result 3
Time
Time
Result 4
Time
Time
Result 5
Time
Time
Result 6
Time
Time
Result 7
Time
Time
Result 8
Time
Time
Result 9
Time
Time
Result 10
Time
Time
Result 11
Time
Time
Result 12
Time
Time
Result 13
Time
Time
Result 14
Time
Time
Result 15
Time
Time
 
 

Looking for more resources?

 
 

Contact our hospital to discuss the best treatment options for your pet.