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Registration test
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Registration test
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Select a practice to register to:
*
Select a practice
Hexham
Bellingham
Stocksfield
About you
Title
*
Mr
Mr
Mrs
Miss
Ms
Mx
Sir
Dr
Cllr
Lady
Lord
Forename & Surname
*
First
Last
Phone number & Email
*
First
Last
Address
*
Address Line 1
City
State / Province / Region
Postal Code
About your pet
Pet name
*
Pet breed
*
Age & colour
*
First
Last
Please select gender
*
Select
Male
Female
Species
*
Select the species of your pet
Dog
Cat
Rabbit
Hamster
Gerbil
Bird
Other
Other - Please specify
Is your pet neutered?
*
Please select
Yes
No
Is your pet insured?
*
Please select
Yes
No
Insurance company & excess
First
Last
Add a second pet
Add a second pet
Pets name
*
Breed
*
Age & Colour
*
First
Last
Please select gender
*
Select
Male
Female
Species
*
Select the species of your pet
Dog
Cat
Rabbit
Hamster
Gerbil
Bird
Other
Other - Please specify
Is your pet neutered?
*
Please select
Yes
No
Is your pet insured?
*
Please select
Yes
No
Insurance & excess
*
First
Last
Add a third pet
Add a third pet
Pets name
*
Breed
*
Age & colour
*
First
Last
Please select gender
*
Select
Male
Female
Species
*
Select the species of your pet
Dog
Cat
Rabbit
Hamster
Gerbil
Bird
Other
Other - Please specify
Is your pet neutered?
*
Please select
Yes
No
Is your pet insured?
*
Please select
Yes
No
Pet insurance & excess
First
Last
I have more than 3 pets
I have more than 3 pets
Let's save a little time here!
If you require any appointments for one or more of your pet's then please register them first. To save you a little time, we can register your other pet's when you come in for your appointment!
Previous veterinary details
Are you joining us from another practice?
*
Yes
No
Name & number of previous vet
*
First
Last
Previous vet address
*
Has your address changed since you were registered to your previous veterinary practice?
*
Yes
No
Paragraph Text
*
Your previous veterinary practice will ask us these details for security and to check they have the right account. Entering these details now will save us having to confirm these details with you. Thank you.
Please confirm you are happy for us to contact your previous practice in order to obtain your pet's records
Yes
No
Allow reminders (appointments, practice visits, home treatments) by
*
SMS
EMAIL
POST
I do not want reminders
We will send appointment reminders and treatment reminders only. Please be aware that if you select no reminders, you will not receive reminders of your appointments or when to give preventative treatment (flea and worm).
Would you like to sign up to our newsletter and to receive exclusive offers and content?
*
Yes
No
We will only email you important information, our newsletter and exclusive money saving offers from the practice.
Do you require an appointment?
*
Yes
No
Our staff have received your registration form. Please allow them 24 hours to get in touch with you.
If you require an appointment sooner then please give your local surgery a call. Alternatively you can book your appointment online (currently suspended due to Covid-19)
Register
£15 off first consultation
Christmas competition 2020
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