New Client Registration

Client Registration

Application to register with Tower Equine Veterinary Surgeons

Your Details

Title

First Name(s)

Surname

Telephone

Mobile

Address

Postcode

Are you a homeowner?

Yes

Have you lived at this address for more than 2 years?

Less than 2 years

More than 2 years

Number of years at this address?

Previous Address 1

Number of years at this address

Previous Address 2

Number of years at this address

Employment Details

Previous Veterinary Details

Has your animal previously been registered at another vet practice?

Yes

Practice Name

Telephone

Animal Details

Animal Name

Animal Passport Name

Animal Stable Name

Breed / Colour

Age

Sex

Height

Address animal kept

Passport Issuer

Passport Number

Microchip Number

Vaccinations

Flu

Tetanus

Other

If "Other" please specify

Vaccination dates

Declaration of intention of human consumption in passport

Intended

Not Intended

Insurance Details

Is your animal insured for vet fees?

Insured

Not Insured

Name of Insurer

Declaration

I am the owner of the animal(s) and agree to pay for all veterinary fees relating to the treatment of this animal by Tower Equine. You may contact my previous veterinary practice for references.

I confirm

Please note that all new clients will be required to pay for each veterinary visit at the time for the first 6 months. Payment by cash, credit or debit card is accepted – no cheques. All client registrations are accepted subject to our current Practice Terms and Conditions and our Practice Privacy Policy