New Client Form

Your Details

Salutation:
MrMrsMsMissDr

Your first name:

Your surname:

Your residential address:

Your postal address (if different from above):

Your email:

Phone number (mobile preferred):

How did you find us: (select from dropdown list)
Walked/drove past/saw hospitalFriend / family / word of mouthGoogle / Internet searchTVH websiteKu-Ring-Gai Council websiteSchools / kindergarten sponsorship, Fete or petting farmWelcome basket / Gift bagFacebookLinkedInInstagramNorth Shore MumsTurramurra Vet email newsSt Ives pet shopOther

If other, please detail:

I Would like to receive an Email Newsletter with free competitions and vital pet health information such as tick season warnings.

Patient Details

Pet name:

Species:
dogcatrabbitguinea pigchickenother birdother

If other, please state:

Breed:

Colour:

Age or date of birth:

Sex:
femalemale

Patient Medical Details

When is vaccination due:

Desexed:
yesno

Microchipped:
yesno

Permission to Request Details from Previous Vet

Patient care and welfare is optimal when we have a complete patient medical history.

Do we have permission to request history from previous vet:
YesNo

If yes, please detail your previous vet:

Pet Insurance

Do you have pet insurance:
YesNo

If so, which pet insurance (select from dropdown list):

AAMIAHMAustralia PostAustralian SeniorsBondi VetBow wow MeowBupaEveryday (Woolworths)Guardian InsuranceGuide DogsHCFHIFInsuranceLineKoganMedibankMiPetPetbarn InsurancePet InsurancePetMedPetPlanPetSecurePetsyPIAPouncePrimeProSureRealRSPCATrupanionVelocity Frequent Flyer1300 InsuranceOTHER (please specify)

and if so, what is the pet insurance account number:

Turramurra Veterinary Hospital does not offer accounts - all invoices must be settled at time of consultation or discharge from hospital. We accept credit card or EFTPOS.

We are registered for GapOnly pet insurance claims. Zip Pay may be arranged for elective or urgent procedures but requires prior approval and may not be available on weekends, in which case regular payment options are required.