Request an Appointment – Douglas Square Pet Clinic1

Name

First Last

Your Pet's Name

Type

Canine
Feline
other

Breed*

Age*

Pet's Age in years

Sex

Male
Female

Address*

Street Address Address Line 2 City Province Postal Code

Phone*

Appointment Date & Time

Office 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 Sat

Date for Appointment*

We are closed on Sundays & Public Holiday Weekends.

Time

: HH

MM

Reason For Visit*

Previous Clinic

If 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)?

Yes
No

Do you regularly come to our clinic to buy your food:

Yes
No

If yes, what kind and how often:

*

I have read and agreed to the Personal Information Protection Policy

Email

This field is for validation purposes and should be left unchanged.

Appointment Request Form

Appointment Date & Time