Slow Vet Medicine

1527 57TH W Avenue
Vancouver, BC V6P 6E9

(604)565-7217

www.slowvetmed.com

NEW CLIENT APPOINTMENT

Note: Upon completion of this form, please call your regular practice and request that your animal companion's complete medical history be released to us either via e-mail to richardcalland@shaw.ca, or by fax to (604) 565-7173.

Thank you for considering Dr Richard Calland and Slow Vet Medicine! Please complete the following form to request an appointment. Availability of appointment will vary depending on your request. Your appointment will be confirmed via phone once complete medical records are received and reviewed. Thank you!

New Client Appointment

Name (required)
First Name (required)
Last Name (required)
Address (required)
Street Address (required)
City (required)
,
State / Province (required)
Zip / Postal Code (required)
Phone (required)
Phone TypePhone Number (required)
E-mail Address (required) :
Animal Companion's Name (required)

Birth Date (DD/MM/YYYY), or Approximate Age (required)

Type (required) :
Breed (required)

Sex (required)

Female
Male


Alteration (required)

Spayed
Neutered
Intact


What type of approach to animal companion care do you feel most aligned with? (required)

Conventional
Holistic
Integrative
Unsure


What is your animal companion's current diet? (required)
Dry
Canned
Air/Freeze-Dried
Commercial Raw
Premium Raw
Home Prepared
Other
If you DO NOT currently feed a whole food based raw or home prepared diet, would you consider making the switch? (required)

Yes
No


Would you agree that safe EMF practices play an important role in overall health? (required)

Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree


Which of the following safe EMF practices are implemented in the areas where your animal companion spends most of their time? (required)
Stetzerizer Filters
WiFi Turned Off
Smart Appliances Unplugged
Smart Meter Removed
Faraday Shield
Other
None
Reasons or conditions for this visit? (required)

What days/times are your generally available? (required)

PLEASE READ
I understand, by indicating I agree and submitting this registration, that I am responsible for any charges incurred by my pet while in the care of Dr Richard Calland - Slow Vet Medicine and that charges are due and payable at the time of service, unless other arrangements are made in advance. Any balance that is carried over a period of 30 days will accrue a monthly finance charge of 1.5% or 18% per annum. Any balance that I leave unpaid will be forwarded to Dr Richard Calland - Slow Vet Medicine's collection agency, and will incur a 25% collection fee for which I am liable, in addition to monthly finance charges.
I have read this statement and - (required)

I agree
I Disagree



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