New Client Form - New Plymouth Vet Group

We welcome new patients.

Prior to your first visit we ask you to complete our ‘New Client Information Form‘ below. Filling out this information in advance will save you time prior to your scheduled visit and provide us with the information needed to ensure our records are accurate.

Also please take a moment to review our Standards of Behaviour policy.

We look forward to meeting you soon.

New Client Information Form

* required fields
Terms of Trade
Our terms are strictly cash, unless prior credit arrangements have been made and approved by the New Plymouth Vet Group. If accounts are not paid, we may charge you interest, legal fees and all costs associated with the recovery of any debt. You must be 18 years or over to open an account with us. Proof of age must be required.
Identification
Proof of ID*
Accepted file types: jpg, pdf, doc, docx, gif, png, Max. file size: 5 MB.
We ask to see one form of identification (driving licence, passport, 18+ card etc).
Your Details
Full Name - Mr, Mrs, Miss, Ms, Other*
Trading Name (Company) / Known as
Street Address*
Postcode
Postal Address (If different from above)
If a PO Box is given then we must have a physical address.
Postcode
Telephone Number*
Email*
Date of Birth*

Day
Month
Year
Secondary Contact or Emergency Contact Name*
Secondary Contact or Emergency Contact Number*
Relationship*
How did you hear about us?
Promotional Materials
Tick this box if you do not wish to receive any promotional material via email.
Monthly Statement
Tick this box if you would like to receive your monthly statement via email.
Consent - Previous Animal Histories*
I give permission for NP Vets to request any animal histories from my previous veterinarian.
Previous veterinarian name and contact number:*
If not applicable please state N/A.
Terms and Conditions
All credit accounts must be paid in full by the 20th of the month following the date of purchase. Any account remaining unpaid after the due date for payment will incur interest and account fees. New Plymouth Veterinary Group reserves the right to refuse to supply goods or services to any person whose account is unpaid after the due date for payment thereof. The customer is liable for any costs, including legal fees, which are incurred by New Plymouth Veterinary Group for the collection of overdue accounts. Completing this application form does not guarantee a credit account will be opened.
Consent*
By ticking this box I certify that all information provided is correct and I have read and understand New Plymouth Vets Terms of Trade and Terms and Conditions.
Companion Animal - Pet 1
Name*
Type - Dog/Cat*
Breed*
Colour*
Sex - Male/Female*
Age/DOB*
De-sexed*
- Add more animals
Companion Animal - Pet 2
Name
Type - Dog/Cat
Breed
Colour
Sex - Male/Female
Age/DOB
De-sexed
Companion Animal - Pet 3
Name
Type - Dog/Cat
Breed
Colour
Sex - Male/Female
Age/DOB
De-sexed
Name
This field is for validation purposes and should be left unchanged.

New Client Information Form

Identification

Your Details

Terms and Conditions

Companion Animal - Pet 1

Companion Animal - Pet 2

Companion Animal - Pet 3