New Client Form

Payment is due at the time of service; we are not able to accept cheques or billed accounts. We do offer the following methods of payment: Cash, Interac, Visa, or Mastercard.
An estimate can be made for services if you desire one

By filling in my name and date below, I confirm that I have read and completed the above information to the best of my knowledge:

I understand that Millbrook Valley Animal Hospital has a Personal Information Policy in accordance with the requirements of the Personal Information Protection and Electronic Documents Act.

By submitting this form, I am consenting to the collection, use, and disclosure of my personal information (such as my phone number and address) in accordance with the purposes set out in the Policy, which include the following:

1. Maintaining complete and accurate client files, and complying with the requirements of the College of Veterinarians of Ontario and the Veterinarian’s Act and regulations under the Act

2. Provide goods and services to veterinary clients, including contacting clients to schedule appointments and follow up on patient treatment, billing for goods and services, notifying clients about new and promotional offers

3. Communicating and working with third parties providing veterinary medical or other services to clients including other veterinary facilities and insurance companies which may pay for all or part of the cost of such services

I understand that:

1. My personal information will not be used or disclosed for purposes other than those for which it was collect, except with my consent, or except where use or disclosure is required by law

2. I have the right to view my personal information and have it amended, if inaccurate or incomplete

3. A copy of the policy will be provided on request