New Client Application Form in Nepean, ON

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A Note to Our Future Companion Animal Families

At Lynwood Animal Hospital, we believe that love is not limited by the size of a body, nor the difference between fur, feathers, and scales. Whether your companion fits in the palm of your hand, perches on your shoulder, or is a supersized and loyal lap friend, we understand that they are a vital member of your family.

As a special interest clinic, we are proud to offer expert care for:

Avian (Birds)
Exotic Companion Mammals (Ferrets, Rabbits, Rodents, Guinea pigs, Hedgehogs, etc)
Reptiles (Snakes, Lizards) & Turtles/ Tortoises
Cats & Dogs

We take immense pride in being an independently owned practice. This independence allows us to prioritize the human-animal bond above all else. It drives our passion to provide a personalized spectrum of care, where our recommendations are tailored specifically to your family’s unique needs and your pet’s specific lifestyle.

We are committed to continuously providing the best possible medicine to our existing client families. As such, we strive to maintain our preventative care program while also serving the urgent care demand in our community for all creatures, wherever possible. Since this is a delicate balancing act, we maintain a New Client Application List. As performance capacity allows, we are happy to welcome new patients and will reach out to applicants from the list on a case-by-case basis, as spots become available.

ATTENTION!: You have entered the NEW CLIENT APPLICATION. This form is for clients who are interested in joining the practice but who have not yet been welcomed into our schedule formally, nor established a veterinary-client-patient relationship (VCPR) with us.

If you already have an appointment booked at Lynwood Animal Hospital, please follow the links sent in your booking confirmation e-mail to complete any necessary documents and to prepare for your visit. If you do not yet have an appointment, please be aware that this is an application that will be reviewed as positions become available – it is not a guaranteed admittance as a client or patient.

Owner Information

Date

MM slash DD slash YYYY

Name

First Last

Pronouns (optional)

Secondary Owner

First Last

Pronouns (optional)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone

Cell Phone

Work Phone

Emergency Contact

(other than immediate family)

Emergency Contact Phone

Have you received care from Lynwood in the past? (prior to Jan 2021, other pet, etc)

Yes

If so, please tell us more

Do you currently have a primary veterinary care provider?

Yes

If so, why are you wishing to make a change?

Where have you received veterinary care previously?

When was your pet last seen by a veterinarian?

To help with scheduling, when is your pet due for their regular check up?

What are your expectations regarding routine health care?

Do you believe in following vaccination guidelines when discussed?

Yes

Do you routinely use heartworm prevention medication (if applicable)?

Yes

If yes, which?

Do you routinely use flea and tick medication (if applicable)?

Yes

If yes, which?

Have you recently had to access emergency/ urgent care locally?

Yes

If yes, where?

If you are a multi-pet household, please tell us about who is in your family (ie number of pets, species, personalities):

For how many of the pets above are you seeking care at Lynwood Animal Hospital?

*note if more than 3 patient fields are needed, please fill in the most urgent/time sensitive in ranked order and check this box to indicate that we need to coordinate more information gathering with you, in order to serve your whole family as desired

Yes, please send me an expanded application form

No, I had enough room thanks

Do you have any specific questions or concerns?

Patient 1

Pet's Name

Age or Birthday

Species

Breed

Color

Gender

Male

Female

Unknown

Neutered

Spayed

Is this your first pet?

Yes

Is this your first time caring for this type of pet?

Yes

How long have you had your pet?

Where did you get your pet?

Does your pet currently have any health conditions requiring management?

Yes

If so, what can we help you with?

What medications, supplements, etc. do you use?

What diets, food, treats, etc. do you use or prefer?

Patient 2

Pet's Name

Age or Birthday

Species

Breed

Color

Gender

Male

Female

Unknown

Neutered

Spayed

Is this your first time caring for this type of pet?

Yes

How long have you had your pet?

Where did you get your pet?

Does your pet currently have any health conditions requiring management?

Yes

If so, what can we help you with?

What medications, supplements, etc. do you use?

What diets, food, treats, etc. do you use or prefer?

Patient 3

Pet's Name

Age or Birthday

Species

Breed

Color

Gender

Male

Female

Unknown

Neutered

Spayed

Is this your first time caring for this type of pet?

Yes

How long have you had your pet?

Where did you get your pet?

Does your pet currently have any health conditions requiring management?

Yes

If so, what can we help you with?

What medications, supplements, etc. do you use?

What diets, food, treats, etc. do you use or prefer?

Medical Records Authorization

Alignment of expectations is essential to delivering the excellent medical experience your family deserves. In an effort to ascertain that your personal needs and our services are well matched, we at Lynwood Animal Hospital seek your permission to request your pet's previous health history file as part of the application process.

I authorize Lynwood Animal Hospital to contact my previous veterinary hospital(s) to obtain medical history and care records for my pet(s).

I do NOT authorize Lynwood Animal Hospital to contact my previous veterinary hospital(s) at this time

Previous Clinic Name(s)

Phone Number/City

Note: We utilize these records to better understand your pet’s unique needs. We will NOT initiate a formal file transfer to our care until 3 conditions are met:

You accept our official welcome into our practice by acknowledgement of our Acceptance Letter
You grant overt permission to us to transfer your files to our clinic
You have a booked appointment

Please note that obtaining medical records will be necessary and mandated in the event that your application is accepted. Accessing previous medical records is a critical step in ensuring continuity of care and avoiding risks associated with uncoordinated veterinary services. In accordance with the College of Veterinarians of Ontario (CVO) Professional Practice Standard: Medical Records – a comprehensive medical history is the foundation of quality veterinary medicine. To establish a proper Veterinarian-Client-Patient Relationship (VCPR) as required by Ontario Regulation 1093, our veterinarians must have “recent and sufficient knowledge” of your pet to safely diagnose and treat them.

Lynwood Animal Hospital

New Clients

Protect Your Pets

Lynwood Animal Hospital

Hours

Like Us On Facebook

Appointments

Get Directions

New Client Application Form

A Note to Our Future Companion Animal Families

Owner Information

Patient 1

Patient 2

Patient 3

Medical Records Authorization

Lynwood Animal Hospital

New Clients

Protect Your Pets

Lynwood Animal Hospital

Hours

Like Us On Facebook

Appointments

Get Directions

New Client Application Form

A Note to Our Future Companion Animal Families

Owner Information

Patient 1

Patient 2

Patient 3

Medical Records Authorization

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