Make an AppointmentAppointment Request Form Name First Last Your Pet's NameTypeCanineFelineotherBreed*Age*Pet's Age in yearsSexMaleFemaleAddress* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Phone*Appointment Date & TimeOffice hours are as follows: Dr appointments 9am to 7pm on Mon and Thu; 9am to 6pm on Tue, Wed and Fri; Starting from 9am on Sat. Retail and Prescription appointments 7.30am to 7pm on Mon and Thu; 7.30am to 6pm on Tue, Wed and Fri; 9am to 3pm on SatDate for Appointment* We are closed on Sundays & Public Holiday Weekends.Time : HH MM AMPM Reason For Visit*Previous ClinicIf we have an opportunity to take a photograph of your pet during their stay, may we have your permission to use the photograph in our clinic advertising (e.g. website, Facebook, in house)?YesNoDo you regularly come to our clinic to buy your food:YesNoIf yes, what kind and how often:Personal Information Protection PolicyDouglas Square Pet Clinic is committed to safeguarding the personal information entrusted to us by you, our client. We manage your personal information in accordance with Alberta’s Personal Information Protection Act and other applicable laws. This policy outlines the principles and practices we follow in protecting your personal information.Personal information includes information about you and your pet such as your name, contact information, and pets identification (age, gender, file number)We collect only the personal information that we need for the purposes of providing services to our clients, including personal information needed to: maintain patient medical records send you requested documentation such as estimates, laboratoryresults, send you appointment, reminders and other medical send you updates on promotional programs that you may want totake advantage of such as dental month or events occurring Send surveys to determine client satisfaction or to help us obtaininformation to help us improve our services to best serve our clients We only collect this information directly from our clients; we will never purchase or share your information with other businesses unless you have given us explicit consent to do so, such as in signing up for a pet health insurance policy or in transferring medical records to another veterinary office.* I have read and agreed to the Personal Information Protection PolicyNameThis field is for validation purposes and should be left unchanged.