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New Client Intake Form

Thank you for choosing Arrowhead Veterinary Centre for your pet’s medical care. We look forward to meeting you and your pet. Please fill out the new client intake form below. There is an appointment request section at the end of the form if you need to book an immediate appointment. Our staff will be in touch with you once your form is processed. If you have an emergency, please call the clinic.

Get Started

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Name *

First

Last

Email: *

Primary Phone Number: *

Phone:

Secondary Phone Number:

Phone:

Tertiary Phone Number:

Phone:

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Spouse/Co-owner/Family member you would like listed on your account

First

Last

Spouse/Co-owner/Family Member's Phone

Client Information

How did you hear about us?

Do you have any immunocompromised individuals or children in your home? *

What other veterinary clinics has your pet been to? *

Can we contact your previous veterinarian for medical information on your behalf? It is important that we receive your pet's previous medical records so that we have their complete medical and vaccination history.

If yes, please electronically sign the Medical Records Transfer form

Can we contact you via email to provide wellness tips or hospital information for your pet?

Why did you choose Arrowhead Veterinary Centre for your pet's care today? *

What is most important to you in a Veterinary Hospital? *

PATIENT INFORMATION

Pet's name: *

Nickname:

Species: *

If other, please specify: *

Breed:

Color and Markings:

Sex: *

Spayed or Neutered? *

Breed *

Colour *

Birth Date / Age: *

ID Microchip Number or Tattoo:

VACCINE INFORMATION

Is your pet up to date on Vaccines: *

Last Vaccine Date:

Which vaccines were given:

PET HISTORY

Are there any other pets in the house? Please list: *

Is your pet on any supplements, probiotics, cannabis products or prescription medication (please list)? *

Does your pet have any known medical conditions? *

Does your pet have any known drug or food intolerances? *

Does your pet have any behavioural issues? *

Is your pet insured? If so, can we release necessary information to your insurer? *

What is the name and policy number of your insurer?

What do you feed your pet? (check all that apply) *

Human foods
Pet foods
Treats
Bones
Uncooked/raw food
Hunts rodents
Other

Please specify: *

Where do you take your pet? (Check all that apply)

Pathway
Off-leash areas
Daycare
Camping/hiking
Obedience class
Pet shows
Agility
Groomer
Hunting

Does your pet live on or visit a rural area? *

Does your pet live with children? *

Does your pet travel outside of Alberta (please list)? *

PET CURRENT CONDITIONS

Do you have concerns with any of the following for your pet?

Drinking
Urination
Appetite
Weight
Skin/coat
Odour
Mobility
Breathing
Vomiting
Diarrhea
Vision
Hearing
Behaviour
Lumps/masses
Dental health
Other

Please explain: *

Do you need an immediate appointment?

If yes, why? *

If you have not heard from the clinic within 3 hours, please call 403-932-2370.

Is there anything else you would like us to know before your appointment?

Ready for a visit?

We provide veterinary services with courtesy and respect to the pets of Cochrane and beyond. We look forward to your next visit! You may schedule an appointment by giving us a call at 403-932-2370.

Appointment

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Where to Find Us

118 2nd Ave West
Cochrane, AB T4C 2E7

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Our Hours

Mon–Fri: 7:30 am – 5:30 pm
Sat: 9:00 am – 2:00pm
Sun: Closed

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How to Reach Us

Phone: 403-932-2370
Text: 587-802-3792
Fax: 403-932-4695
Email: info@arrowheadvet.com

Have a question?

Get in touch! Complete our online form, and a member of our team will be in touch with you shortly.

Name *

First

Last

Email *

Phone

How can we help you? *

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